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!

She's Too Radical

When I look in the mirror these days I see a caricature of Mrs. Tiggywinkle. My body changed over the past ten years. Even though I still run four kilometers three or four times a week, and I feel quite fit, more or less, my shoulders have changed shape, my waist has thickened, my grey hair is down to my bum but no one ever sees it because I wrap it in a scarf, and...well, I feel different.

Mrs Tiggywinkle, however, is a laundress. She is an independent female: round in shape, granted, and she is a little perhaps neurotic, but she takes care of herself, of her small house, does other people's laundry AND makes friend with a little girl in distress.

And she's got fearsome prickles.

Is she radical?

I met a prospective client the other day. Lovely woman, nice partner. She had heard about me through one of the long grapevines that eventually lead my way. I'm not big on advertising, publicity, I never wanted to be on Oprah, and I don't have a fan club. So people usually hear about me from other women in a round about way.

But this lady had gone through a list of doulas in Montreal, found them wanting, and came to me. And she expressed one doubt, which was that I may be "too radical".

Radical has its root from root: from Late Latin "radicalis" ("of or pertaining to the root, having roots, radical"), and from Latin radix (“root”).
And the definition is: Favouring fundamental change, or change at the root cause of a matter. 

What is the root cause of the birth matter? I believe the root cause of abusive maternity care shares its root with woman abuse in every aspect of our lives. So, in "favouring fundamental change", I am going to go to the root of the matter. I am not going to spout empty slogans and run other women's lives according to my agenda.

The root of birth abuse is a culturally useful and familiar disrespect for women in general, and for birthing women in particular. If I am going to practice as a radical doula, then my priority will be respecting the birthing woman. To this end, I will not persuade her to make choices that conform to me agenda. Ever.




The woman I met may have been imagining a furie, a Roman goddess of vengeance, guarding the door of the birth room with an eye to exacting payment for past wrongs.

The furie would insist that the woman follow her rules: no interventions, under any circumstances; upright positions throughout; lots of vocalizing required; partner hands-on at all times.







But radical doulas are not furies. We respect the desires of the women we accompany. We melt our egos and support the woman's choices. Our agendas stay at home. We are just and fair, possibly to a fault. It is a fine line between supporting a woman during childbirth and feeling like you are witnessing, indeed apologizing for, an abusive act that should be named. But in the naming, the birth process is damaged. Our role is to bear witness, to take notes, and to love the one you're with.

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!

A Crack in the System

A couple of years ago, when I was deeply into my work at my cafe, and running longer and longer distances, I told my husband at some point "Yeh, The Man won." I meant that crippling internal conflicts had brought me to a decision to abandon my volunteer doula organization; that the arrest and conviction of unregistered midwives in Canada and around the world meant that women were left with less and less choices; and that my simmering suspicions about the nature of feminism were possibly true. 

So, I took pleasure in my cafe. I ran faster and had a load of fun doing races. I made new friends. I ignored the birth world, and only answered a call if one of "my" students had a question about a birth or a pregnant client of theirs. Occasionally I would check in with midwife friends around the world, just to check in. I was happy giving it all up. I put my doula bag away and forgot about my plans to go back to Greece to attend women in the camps there.

Then that crazy virus hit and I spent two month at home, with my family (husband, two sons, nephew). I made myself a small cocoon, and I crawled into it and meditated, thought, wrote and pondered. And then women started calling me. Women who had planned to give birth at home but whose midwives were forbidden to attend. Women who planned to give birth at the hospital but their doula were forbidden to attend. I gave advice, gave comfort, affirmed choices, made suggestions. 

I met with a few women who were planning to give birth in their own homes, without a midwife in attendance. I spoke to them after their births and got the idea I would interview them for an article or a podcast episode. Then I looked at the footage and I realized - you women are amazing by the way! - that I have some beautiful, inspiring footage. And then I realized, yes well, women experience less-than-optimum births and they're also worth interviewing....

So, now I have interviewed about thirty women, I have so much beauty on my Google drive and so many words of wisdom... so I'm making a documentary to celebrate our strength, tell our stories and let the world know that our care of the birthing woman needs change and needs it NOW!

There is a crack in our maternity care "system" and women are falling in. Luckily, the Covid crisis is a chance for us all to have a little time to check in with our reality and make some changes. Fast. 

Some questions to ponder:

• Why are women expected to "reach for the top" in their professions and then called "too old" when they decide to bear children?
• Why are women expected to go to the hospital to give birth? As we now know, hospitals are where sick people go. Pregnancy is not an illness.
• Why are women threatened with the death or morbidity of their babies, while they are in labour?
• Why are there so few midwives in Canada?
• Why are doulas so expensive? Is a birth companion a luxury?
• Why do women feel ashamed for their birth experiences?

And some mantras to reflect on:

• Nature is not gentle, it is powerful and untameable.
• Heal birth, heal earth.
• Powerful women can change the world.
• Just a reminder, when a woman gives birth, she is BIRTHING A NEW HUMAN! 

So, I have my work cut out for me, and I am feeling good.

If any one of you wants to participate in any way, let me know: do you want your voice to be heard? Do you want to be involved in production? Do you have an idea you want to tell me about? 

I'm listening!

Manifesto

MBC Doula School Manifesto

A doula is … a birth attendant, who provides many and varied resources for the family-to-be during the childbearing year. This was a common role from ancient times up until the 20^thcentury, when it died out when hospital birth became the norm. Before hospitals were the places where women went to give birth, a midwife would attend a birthing woman in her own house and there was usually another woman or two, or an apprentice midwife, who would help with the extra tasks like giving the woman a back rub, or fetching warm cloths, or cooking some food, or encouraging the birthing woman when she needed it.

Back in ancient times, in some cultures, there was a circle of women who attended the birth and cared for the birthing woman carefully and with love. In other cultures, however, women birthed alone in a solitary hut and sometimes things went well and sometimes not. Romancing the past is not a good thing when it comes to the history of maternity care: maternal and neonatal mortality and morbidity rates have decreased consistently over the centuries.

Starting only about 150 years ago in the industrialized world, women started to go to hospitals to give birth. This created all sorts of problems, not least of which was massive levels of infection because medicine hadn’t yet discovered the important role that hand-washing plays in preventing infection. Just as importantly, women were going to the hospital on their own, separated from their families, and were being cared for by people they had often never met. By the mid 20^thcentury, hospital birth had become the norm, or at least a sign of wealth, in many parts of the world.

But there were serious problems with this alienated way of giving birth, and these problems are increasing day by day. Birth in the industrialized world has become a mechanical event, monitored by machines. Increasing rates of surgical birth have led to health problems in children. The cost of birth is rising. When this model is transferred to parts of the world where the infrastructure is not sustainable, the results can be catastrophic.

In the industrialized world, those of us who bear children feel alienated from the process of birth. This alienation makes us reach out to others who can perhaps accompany us through the powerful process of giving birth. We know that the presence of another person in a birthing room, who is not emotionally connected to the birthing woman, decreases labor time, decreases requests for pain medication, and decrease the use of surgical and other interventions. This companionship gives the woman a sense of peace that enables her to look back on the experience with more satisfaction.

At the same time, in most of the industrialized world, midwives have become a very small part of the maternity care team, and the huge majority of women go to the hospital to give birth attended by medical doctors. The doula enters into this world as a companion, a guide, and an advocate but doulas do not provide maternity care for mother and baby. The doula sometimes finds herself in conflict with the recommendations put forward by the doctor or midwife, but she cannot voice her doubts. She is a companion, a vessel, an advocate.

In the early 1970’s, Klaus and Kennell were doing research on the moments after birth. They were wondering how mothers reacted to their newborns; what are the consequences of how a mother treats a baby when the baby is born. How does a mother attach to a newborn? How does the newborn react to the mother? Are there lasting effects from these few moments after birth?

Their research shed light on another interesting fact, and that was that the women who were being observed were actually affected by the presence of the observer, and if the observer was encouraging and present, the labor time was shorter and the birth was easier.

The modern doula was born. The term was appropriated from the Greek. It was a cultural appropriation that, as most linguistic borrowings are, was slightly inappropriate. The ancient Greek word that it appears to have been borrowed from means “female slave” or “handmaiden” as in “behold the Handmaiden of the lord.”

In 2003, I started a doula training program with another Montreal doula, Lesley Everest. We were already practising doulas, and we were noticing that there was a growing need for doulas in our city. Because of the particulars of maternity care in our area (large, multicultural metropolis, with a struggling infrastructure and poorly paid medical professionals), it was difficult to integrate doulas into the maternity care team. Birth abuse was common, and inexperienced doulas were often traumatized by their experiences. A short weekend workshop about normal birth, and an introduction to the basics of doula care were not enough for these doulas, and they were suffering.

Our course was an intense, comprehensive course that covered almost a full year, and included hours of class work and some shadowing opportunities.

Part of the students’ requirements included fourteen hours of volunteer time. Students started volunteering at the Montreal Diet Dispensary, which provides free food and other resources for mothers in need. They soon realized that these mothers also needed free doula services, and so the students started offering this service. Montreal Birth Companions grew from this small start.

Over the years, the partnership between Lesley and I dissolved, and I concentrated more on the volunteer organization. I was providing free training and mentorship for the volunteer doulas, as well as running a private practice. MBC grew over the years, and now provides doula care for over one hundred clients a year. That’s $100,000 at the average market price for doulas in Canada. I realized that I needed to provide a more comprehensive training for the volunteers, and I could provide MBC with eager, dedicated volunteers through\ the training program.

MBC Doula School grew from this idea. I started with a Level One doula training that provided students with the basics of doula care, enough to give them the skills to accompany a mother through her birth experience together with a partner doula. The Level One training also provided the opportunity for the students to shadow a more experienced doula, until they felt comfortable taking on a client with a partner.

Level Two is the next step, and it is much more comprehensive and gives students the skills they need to provide full care for a birthing mother throughout the childbearing year.

The next step was a natural progression that is in tune with my beliefs about education and knowledge. I provide doula students with much of my own beliefs, philosophies, and approach. They read my book and study for hours under my guidance. I wanted to open up their education by inviting other teachers and guides to provide a different voice, and more varied skills. To this end, I have invited high profile teachers from around the world, and I also invite local guest teachers who are active in the community to share their skills with the school.

I think my general philosophy about life informs my specific beliefs about birth, so I will touch on them briefly. Fundamentally, I do not believe that the particulars that make up our lives can be fully controlled by our desires or actions. As midwives say, meconium happens. However, I do strongly believe that we are responsible for our choices: it is up to us to inform ourselves, make decisions, and then live with the outcomes of those decisions in a conscious and responsible way. How does this reflect on my beliefs about birth? Essentially, I try my best to facilitate an excellent birth experience for a mother and family, and when I am the sole caregiver for that family, I take my responsibility for the safety of the mother and child very seriously. But I do not believe that the ultimate outcome is up to me. The buck does not stop with me. As the Muslims say, pray to Allah, but tie your camel to a tree. So, I interpret that to mean: do all you can, your very best, to ensure a good outcome for mother and baby, but know that all is not 100% in your hands.

Cutting-edge scientific research in the 21^stcentury is focussing more and more on the interconnectedness of things and forces, moving away from a trend that started in the 17^th century which attempted to break down the world around us into easily digestible units.

Unfortunately, modern medicine has not yet jumped into the 21^st century, so we are still burdened with an understanding of the human body that sees it as a collection of pieces that function well together, but are essentially separate. As professional physicians became more a part of our lives in the industrialized world, we also lost the sense of responsibility for our own health care and tend to shift that responsibility and power to our doctors. Add to this precarious mixture a culture that is based on fear, and that uses military metaphors even to sell yogurt (“the best defense”!), and we have a birth culture that is malfunctioning and hurting families. Mothers go into the doctor’s offices afraid of birth, worried that their bodies will not work properly, believing that the doctor knows more than them, and believing without question what the doctor suggests.

My fundamental belief about childbirth is that the human body is perfectly capable, in the vast majority of cases, to give birth to a child without much help, intervention, or trauma. I believe that birth is a physiologic event that is part of the normal function of the female human body. I believe that mothers do not need lessons or techniques to learn how to give birth, but rather, that they often need to be untaught fearful or pathology-based reactions so that the body is allowed to function normally.

I believe that there are ways that a normal birth can be prepared for by the mother and expectant family. These include:

v  Effective prenatal care, including nutritional counselling, a minimum of interventive testing, informed choices throughout the process of pregnancy, labor and birth

v  Prenatal education focusing on physiologic birth, made available for the mother and partner.

v  Community support and resources readily accessible and affordable for all families.

I believe that the control of women’s bodies has been one of the essential characteristics of human life for thousands of years. It may have originated in the disturbing fact that a male could never know exactly who impregnated whom, but that is not important now. The fact that remains, however, is that we live in a culture where the fear of birth and the birthing body is paramount. All over the world, birthing women are abused and violated, usually without their consent. I believe in the value of informed choice, but I am also aware of how the “informer” can bend that information to suit their own political will.

I believe that every single time a birth unfolds without violence, the world and human society is healed a little bit.

My approach to healing and medicine is holistic, in the fundamental sense. I appreciate that most of the tools we see used in maternity care are tools that have appropriate use. While most of them should not be used routinely for every pregnancy or birth, many of them save lives when used in the right way at the right time.

Many birth practitioners make the mistake of assuming that just because something is deemed “natural”, it is fine to use it in any situation with any mother. This is not the case. Neither is it the case that more interventive tools should be used routinely. Midwives and doctors certainly need to use certain tools to monitor a pregnancy and birth. Tape measures are useful in recording the healthy progress of a pregnancy. Hands are immensely useful at all stages of pregnancy, birth and postpartum as diagnostic and healing tools, as are our senses. And of course, there is equipment of all sorts that can and should be used, or at least made available, for every pregnancy and birth.

But we don’t need to use very much equipment or procedures at all if the pregnancy or birth is progressing well and we can see (or hear) the signs of health in the mother and baby.

Education is the most effective tool at our disposal. It is, obviously, what MBC Doula School is all about! But education is much bigger than a doula school. It is every birth story you read on the social media. It’s every conversation you have in the grocery store. It’s the gruelling education that physicians endure in medical school. It’s every one of us, throughout our lives, making choices.

I believe that knowledge is a public resource. It is a vibrant source that changes with each generation, and is constantly being added to and modified. Human knowledge is what makes us human.

As our birthright, it should be shared freely. Those in the business of sharing knowledge and skills, however, need to be paid for their work, and that places knowledge within structures that can be limiting.

Education itself can be limiting, when it is bound by hierarchical, fossilized power structures. Just as the doctor/patient relationship can be one of the powerful and the powerless, so can the teacher/student relationship. When this kind of educational dynamic is established, the student gives up responsibility for active learning and ceases to question, to challenge, and to learn.

MBC Doula School grew out of my thoughts about education and birth. I was teaching a successful three-level doula training. I freely shared everything I knew with my students, for a fee. I gave them practical training and mentorship for free, and for as long as they thought they needed it. I still have former students asking my advice for their clients.

But I am just one voice, one pool of knowledge, one history. There is a whole network, in our city and in the world, of teachers who are eager to share their knowledge and skills, and MBC Doula School is a forum where they can do just that.

MBC Doula School has many students who have gone through the training and then hope to start midwifery education. My advice to them is to attend as many volunteer births as they can. There is always more to learn. It is better if every single birth teaches you something about birth.Many of the MBC Doula School students are still young. Traditionally, midwives have been older, finished with the task of raising small children. I counsel patience to these young doulas. The more births they attend as doulas, the better midwives they will become.

MBC Doula School is the child of Montreal Birth Companions. I have seen that the experience the students gain from their volunteer work with MBC makes them better prepared to enter training for many other professions, from midwifery to medicine to social work, nursing, and more.

Specifically, for students hoping to become midwives, the task of accompanying marginalized families through the childbearing year gives the student exceptionally valuable preparation for a life in midwifery. It prepares them for a life of giving; it teaches them about the medicalization of childbirth; it shows them how to accompany a mother through labor and birth using the lowest technology available (doulas do not use high-tech equipment at all, so they have to rely on their hands, their senses, and some gentle tools); it teaches them humility and cultural sensitivity.

There is a lot of discussion these days about the benefits or ethical meaning of midwives, doulas, and students traveling to poorer countries and gaining experience in birth by providing their services to the families there. There are definitely ethical problems with this model. I believe that student doulas and midwives should look closer to their own communities and focus their volunteer efforts there. There is no need to go elsewhere looking for poor people to practice on. The issue for fully trained midwives is obviously a different one, and every midwife must chose for themselves how they choose to practice. If we start to see that the world is a living, breathing entity, then we will understand that the experiences we need are often just around the corner.

In a more specific sense, the extended family of people surrounding MBC Doula School and Montreal Birth Companions have a strong sense of community, and I strive to nurture that sense. Over the next few months (by June, 2015), we will be teaming up with the Caffe della Pace to provide a physical space where students, doulas, clients, people can meet and share their stories. This community, I am hoping, will be a source of fundamental change in the birth culture in our city and hopefully part of a worldwide movement.

We are now located at the Caffe della Pace, a home for good food, good vibes, and positive change. Please come by and join us!

Trickle Down?

Let's face it ... good stuff doesn't trickle down. You have to work really hard to get the good things in life to the people who deserve them: shelter, medical care, food, clean clothes, and all of those things that many of us take for granted.

In the last ten days, I have had over ten requests from women who desperately need maternity care. I can only provide them with free doula care, from the volunteers who donate their time to Montreal Birth Companions. Some of these volunteers are students, some are experienced doulas.  But doulas don't provide medical care, and most of these women have not had prenatal care, so they are at risk for worse outcomes than the generally healthy population of our fair city.

I was called at 2:30 in the morning last week by a doula, frantic with worry. She had been called by one of our clients who was bleeding heavily. I told the doula to call 911 immediately. She did so and mother and baby survived.

Several times over the past week I have been juggling available doulas to accompany one of the MBC mothers who was laboring and needed companionship. Doulas are people too, some are on vacation, some are pregnant, most have other jobs.

I assisted at a birth where the midwives were unable to provide the mother with effective care postpartum. I was at another birth with a baby who became ill after birth. I got another call from a doula whose client was bleeding after giving birth, and the midwives had not made it to the house on time.

I have had several requests over the past few weeks from mothers who cannot find a midwife, who don't want to birth in the hospital, who are looking for an unregistered midwife. Unregistered, underground, or illegal midwives work without any medical backup and if they need to transfer their clients to the hospital, have no standing with the medical staff and are treated either as doulas or as "friends". Unregistered midwives often make calls that are not as effective as they could be - they work on a basis of mutual respect which sometimes can mean taking risks that may be dangerous and unprofessional.

I am seeing the writing on the wall, and it is telling me that we are not taking care of our mothers and babies. I can't always be there to answer the phone when a mother is in need, or a doula, (and rightly so) cannot provide medical care when there is no doctor.

Something must be done! Se non ora, quando?