Birth (and life) after Cesarean

I love to listen to birth stories. Many of the stories that I hear are a testimony to the pregnant woman's great ability to "animal out" on her attendant. My favorite is the story of a young woman who had her first daughter by cesarean section She became pregnant again the same month and it turned out she was carrying twins. Her doctor was very alarmed and booked her for a cesarean at 38 weeks, She went into labor at 36 weeks and delivered two lovely girls, vaginally.

Of course, women who are trying for vaginal birth after cesarean don't always have such fine stories to tell. Two remarks have stayed with me over the years, and these were both delivered by obstetricians to a laboring woman. The first was: “Childbirth is like war, and I am on the front line.” The second: “This is Monday morning in a busy hospital. There are road accidents, emergencies …” This was said to a woman who wanted to labor a little more before the decision was made to go to surgery, implying that the birth of a child had to be scheduled in somehow between a messy car accident and some other horrific case. Why did this man want to become an obstetrician? How did he feel about his "patients"? How had he been born? What was it about birth that suggested to him images of war?
What is it about childbirth that makes these people think in terms of war, car accidents, death? Is it just fear? And if it is, what exactly are they afraid of? And , more importantly, where does the midwife fit into this mosaic of fear, or does she fit in it all?

Doctors and midwives who are afraid of childbirth are partly afraid because of their training. Allopathic medicine teaches about pathology rather than the whole healthy being, and pregnancy is often seen as a pathologic condition. But there is another more profound reason for this fear, and it has to do with the fact that Western medical training teaches health workers to rely only upon their own knowledge. How does this lead to fear?
Let me explain. During childbirth there is something present that is outside of us as individuals, out­ side our knowledge, even outside our experience or our skill. That "something" has to do with faith. It is only with a leap of faith that you can appreciate or even accept that a new human being comes out of a woman's vagina. Without that leap of faith, what happens? Two things: more obviously, you have to interfere, pull it out, cut it out another way. But another thing happens as well. Strangely, your faith (most of us have faith in something) gets turned inwards. As an obstetrician, you have faith only in your own skill. And that is what is frightening-- that an event which cries out for the presence of God gets reduced to the simply human.

I'm sure that there are obstetricians who works differently, but I think that it is easier for a mid­wife to accept that there is something else, something larger than herself, working through a birthing woman. It is quite noticeable how many mid­wives are religious, how many live in sight of that something which many people call God. But what happens to the sympathetic midwife working within the medical system? What happens to her sensitivity to that Other which touches us when we give birth?
I have met many diverse people over the years of working with birth.I have encountered some women who probably disliked their work, who were overtired, overworked, who had little faith in any­thing. I have also encountered mid­wives who have accepted modern medicine's vision of birth. And I have met many brave and gentle souls doctors, nurses, midwives, and doulas, who are working within the medical sys­tem and trying to maintain their faith at the same time.

What do we see in a hospi­tal? We see, first of all, an exagger­ated reliance upon technology. We know that the use of technology has a snowballing effect, creating the need for more and more complicated interventions. Secondly, we see a rigid hierar­chical structure in which usually one person is calling the shots. Finally, we see the "spiritual" infrastructure upon which this hierarchy is based, to be inward looking and grounded only in human knowledge.
What happens in the hospi­tal when things start to "go wrong," when things don't follow the pre­scribed path? When I went into the hospital in labor with my first child, the nurse, who was actually a mid­wife trained in Scotland, touched by belly and said cheerfully, "This baby will be born by noon." As time went on, she touched me less and less. By the next morning at the start of her shift, she didn't even greet me. As they let me eat and drink less and less, my cervix grew smaller, I was touched less and I began to feel more and more isolated. I was touched only when necessary. The baby's heart­ beat was checked less often. I began to feel abandoned.

Can I offer some advice to birth attendants working with women who are hoping to give birth vaginally after a cesarean section? Remember that the previous cesarean(s) have left scars not so much on the uterus as on the woman's sense that she is capable of giving birth. Accept that having a cesarean can hurt. Please don't de­scribe to her how a ruptured uterus may feel. Watch for danger signs yourself. Keep your concerns to your­self as much as possible. Remember "failure to progress" can be linked to fear and stress.
Keep things easy even when they get hard. Remember that a woman work­ing for a VBAC needs the comfort and security of her own home. Remem­ber that she may need to work on building confidence, on throwing away fear, on finding her "animal" self. Re­member as well, if it turns out to be another cesarean, don't abandon her. Give her the support through the birth and afterwards that you give any birthing woman. If a lady has another cesarean, she may feel very low; it may help her to talk to another mother who has been through the same thing. Avoid the mistake of "You're lucky the baby's okay.That's the important thing." Yes it is, obviously, but ... she may still need to grieve.

I am lucky - I have been blessed to have attended many successful VBACs during my years as a birth attendant. Thank you, again, to all the women who have shown me how fearless and strong birthing women are - not least, the woman who have said "Yes, I am ready for surgery, of course, if my baby's life is in danger."
Here's to a happy marriage of modern medicine and safe midwifery, with lower cesarean section rates and happier and healthy mothers and babies. L'Chaim! To Life!

Day One, two, three

Everything here in northern Greece has been slowed down incredibly because of the snow. Of course, being from Montreal, I can laugh at the 6-8 inches we have here, but the fact is that many of the roads were closed on Tuesday, and my car has been sitting at the bottom of the hill so that we could be sure of having transportation, even if we have to trudge through the snow and ice to get there.

Monday I arrived:

Tuesday I got settled. Bought some groceries for myself, and a hot water bottle! I froze in my bed on Monday night and thought about the people living in tents or on the street. I had to park my car at the bottom of the hill and walk up with the groceries ... then later I walked back down with another Canadian volunteer to get chains for my tires. No snow tires here! 

Wednesday we went to visit a family with a newborn. Lovely family, we spoke at length with the neighbours, listening to their heart-wrenching stories. 

There was a field, dogs running, birds swooping down onto the snow, kids running and playing.

A child rolled around on the floor playing a noisy game on the phone. Her parents kept reminding her to turn down the volume. Sound familiar? 

A man was building a snow sculpture on the wall of the building. Maybe he taught art at the university before he was pushed into this life, or maybe he was a graphic designer in an advertising company.

You have to realize that the people - "refugees" or whatever labels you use - they are people like you: they have lives, families, kids, phones, tablets, worries, ... did YOU ever imagine you would be living in a tent? Neither did they.

Today we will be distributing food and necessities to other families, and visiting prenatal and postpartum mothers. It's a beautiful day.

"What can I do?" We are all asking ourselves. You can volunteer:  check out this link if you have free time and energy: http://www.greecevol.info/index.php

You can donate money: have a look, see what you want to support. There are organizations that work with every different sector of the population: children, mothers and babies, housing, employment...health ... 

You can get political. The borders are closed. People are stuck in the southern European countries with no work and no status. Their families have been torn apart. The political realities seem unchangeable and too complicated for normal people like us to change. Perhaps this is true. Then do your part to change the small things. Support the refugees in your country and make them feel at home. 

We are not made of snow and ice. Together, we can change the world.

T is for Tea, and so grateful for a cuppa tea.

T is for Tea, of course. And just as a conversation meanders around a pot of tea shared among friends, so this conversation slowly and circuitously will get to the points.

My mother worked teaching mathematics and then she went to art school, but I always remember her being around in the evenings, ironing, listening to the radio, and whenever I got home in whatever state I was in, she would offer me a nice cup of tea. That meant strong, very strong, hot, with milk and usually sugar. Maybe a piece of dark chocolate along with it that you could dunk. 

Anything could be solved with a cup of tea! Or at least, you would feel better if you drank a cup of tea while dealing with your stuff.

I never realized until she died that it was really and truly possible to love someone and pretty much hate them at the same time. Or, that love didn’t necessarily cure all the awful effects of betrayal and those kinds of things that can inhabit a marriage.

I learned from her that life is a long process of learning how to inhabit contradictions.

Back when I was a hipster, before hipsterdom had come into being, I had two outfits: a pair of army pants and a turquoise and black striped cotton skirt. I wore them with a green boy scouts shirt or a neon pink lycra polo. I had a good luck bird tattooed on my chest. I never gave anyone the time of day. I must have been a pain to get along with. I was tough. I tried everything but got stuck to nothing. I was barred from the Alcatraz for throwing a table. I hit an Egyptian man in the chest with a rock when he whispered fucking to me on the street in Cairo.

I inhabited a world where poetry reigned supreme, and justice was always possible, with enough struggle.

I traveled through Africa alone because that’s where I was born.

I got a degree in ten years, because there was always more interesting stuff to do.

I had babies, lived on a self-sufficient organic farm, learned to be a midwife, joined and left a religious cult, kept a marriage going, started running, cooked food for myself and others, left continents and returned, learned and forgot languages, and through it all I have never inhabited the high ground to your low ground. And I refuse to inhabit the low ground to your highs.

There is no high ground. When you imagine that the ground you inhabit is higher than others, you start to sink and that sinkhole, although attractive, is ultimately another illusion. One time we were sitting having tea on our farm, amongst the mess and chaos of small children and a subsistence farm ... and my mother's cup lost it! The cup of tea just dropped in to her lap and she was left holding only the handle. Wipe up, crack up, use the handle-less cup for a paintbrush holder, and get on with it, in true Cockney fashion.

So here’s a cup of tea to you, and here’s to having a cup of tea with each other, and here’s to all the things that may or may not begin with the letter “t”, and here’s to living deeply: deeply within and surrounded by contradiction and paradox. Here’s to continuing to have friendships and relationships with people who don’t necessarily see eye to eye with me, who don’t agree with me, who don’t understand where I am coming from. Here’s to long nights of discussion and here’s to building a strong house of thought using the bricks and mortar of our own imaginations. Here’s to open hearts and open minds, to loving and hating, to sadness and intense joy, to night and to day.

Seven Billion!!

I heard today, as many of us did, that the world's population is estimated to have reached 7 billion people!

Let's not speak of low resources, climate change, and gloom and doom, but let's celebrate this 7 billionth baby's birth with a cheer and a toast, to good health, happiness, and longevity for us humans. I'm sure we can find a way to make it all work.

More interesting to me is the likely fact that this baby was probably born at home, with the attendance of a traditionally trained midwife. I do not advocate going back in time to the days when women died in childbirth, but I do believe that home is the best place to conceive and the best place to give birth. I offer a vision of birthing the future from my book:

My vision is one of most women giving birth at home, with full medical back-up available to them if needed. Midwives would provide prenatal care and accompany the laboring women through labor and birth. They would assist with the postpartum period and help the new mother adjust to life with a new baby. If there were problems, the midwives would refer the woman to a doctor, who may in turn refer her to a specialist, an obstetrician. Full emergency support would be in place for the rare occasion that it is needed, so that the midwife would know that she is covered in the case of an emergency. 

The women who chose to give birth in the hospital, in my dream world, would be there because of clear medical or social need. The hospital birthing centers would provide specialized medical care for the few women who need it. Occasionally, there would be a woman who needs the extra emotional support of a doula, but the doula would be well-integrated into the hospital system and would be on call in these situations. Sometimes a woman would want to give birth away from home, and she could go to an independent birthing center which, again, would be fully supported in case of a medical emergency. 

I do not believe that this vision is so far off in the future, or that it is out of our reach. For now, however, our reality is that most women in the developed world are giving birth in hospitals, and many of these hospitals have different philosophies about birth than many of the patients they are there to serve. In Canada, the philosophy of any hospital must be to provide the best care for the greatest number of people. This may translate into an epidural for every woman, especially if there are not enough nurses to support each woman individually. In the USA, hospitals are run as profit-making enterprises, so the word philosophy may not apply. We do know, however, that cesarean section rates are skyrocketing, and that the general consensus is that a national rate of about 15% may be optimum. Personally, I believe that the rate for emergency cesarean sections can be held to 5% without putting the mothers or babies at risk.

The doula is the interface between the birthing community and the medical establishment. This puts us in a difficult position. I have spoken to  women who thought that I would leave them to give birth alone if they decided to take an epidural (this is beyond cruel). I have been yelled at by a physician who thought I had removed an intravenous drip (the nurse hadn’t had time to put it in). I have been looked upon as a knight in shining armor (I don’t even like horseback riding) by women who had not yet understood that the birth work is done by the birthing woman.

     I have also been thanked and cherished by hundreds of women who have been happy to have me by their side as they go through the experience of giving birth. My task, our task as doulas, and in a bigger sense, our task as human beings in the 21^st century, is to “humanize” birth. To me, that means affirming that all of us are different, and that we all have needs, desires, and histories that cannot and should not be judged. My job as a doula is to create a space in which a woman can reclaim her knowledge of birth and give birth according to her own birthright.

Birth Day

I posted a picture on Facebook the other day. The young man is my son’s good friend, and he is visiting us up on the mountain. His mother posted a comment about remembering when he was a baby – as we mothers do. I love watching my sons grow into men, and marvel at the fact that, for me, they retain that quality they always had, that I loved when they were babies and young children, and still love now.

One of my sons turned twenty-five this summer. I remember when I was in labor. We were living in a beautiful farmhouse in Tuscany that belonged to a famous yoga master (I only knew her as my landlord back then, not being initiated into the realms of yoga and the like). I labored and labored, and I remember the farmhand and his wife coming to visit, dressed in their Sunday best. The day before, I had watched him picking apricots in the field below. Their daughter had started labor at the same time as me, had delivered, and was cuddling her baby in bed, so they thought I would have a baby to show off as well. We told them we would let them know when the baby was finally born, which he was in due course.

When I got home with my newborn, the landlady’s daughter came to visit, bearing a huge bunch of blue cornflowers. I can never see cornflowers growing, or apricots being picked, without thinking of those few days of labor and birth. I remember the taste of the rice ice cream I ate while I was laboring.

Apricots, ice cream, flowers, babies, love ... summertime!

La Mamma!

I was lucky when I had four little ones, because I lived in Italy, a country world-renowned for its art and culture. What? You are imagining I took my four rambunctious boys to the museums? No! The museums came to us ...
There was one image that was always around, and that was the image of a mother and child. Everywhere I looked, when I first arrived in Florence with my oldest, who was then a babe-in-arms, was an image of a beautiful woman with a baby on her lap. The religious details didn't mean anything to me - but the beauty of that image moved deep into my soul and colored much of what I believe about mothering.
I was honored back then. It was a generation that wasn't too reproductive, and we made up for it by having four boys each two years apart. Everyone looked at me with admiration, though they thought I was a happy fool. A peasant once drew me aside to ask me if I knew about "the pillola" - the little pill. I was happy in my ignorance and enjoyed the fertility of that life.

I look at my clients here in a city that is under snow much of the time, where children are considered a nuisance, and the best times are when mom and dad get to go out on their own, and I admire those women I meet who devote their immense energies to being with their young ones. I work with women to achieve their optimum birthing experience, but often I find I am giving support after the baby is born and named - when the mother wants assurance that she is doing the right thing by holding her baby when he cries, or she wants her baby to sleep with her, or she keeps her two year old home from daycare. It is hard enough being a mother without having to cope with everyone else's ideas about what you should or shouldn't be doing. If only we could honor mothers just for being mothers! I felt I received that honor, when my boys were small - no one knew who I was or where I was from, but when they saw me with my children, they congratulated me. I was fulfilling the honorable task of raising babies.

To the mothers having and raising babies! To the women who support them!

A Peek into the Doula's Year

… you are assisting at someone else’s birth. Do good without show or fuss. Facilitate what is happening rather than what you think ought to be happening. If you must take the lead, lead so that the mother is helped, yet still free and in charge. When the baby is born, the mother will rightly say: “We did it ourselves.” Tao Te Ching

January 23 … I make myself comfortable on the couch in the living room … they have the lights on low and there is a sweaty, earthy smell in the air. The cat hovers around my ankles. I hear another contraction coming and going. Its 3 a.m. and I have been here for two hours. In the morning, we will go to the hospital, driving on the highway at dawn. The baby will be born by breakfast time. Everything is good.

March 16 … I am sitting in the Jacuzzi room, kneeling quietly next to the bath as I splash water on her back.

July 3 … She wants to dance during contractions, back and forth across the small room, keeping me moving as she holds my hands.

October 1 … I speak gently to the father-to-be, explaining that her pain is normal and his anxiety is perfectly natural.

December 23 … She calls me at home at 2 a.m. I awaken and answer the phone quietly. She says she is in labor and wants me to come to her. I hear from her voice that she is not ready so I speak to her for a while through a few contractions and suggest that she tries to sleep. She calls me at 7 a.m., after sleeping for four hours. She was woken by stronger contractions and she calls me to find out if it is time to go to the hospital. I reassure her that she is coping very well and I talk her through a couple of contractions over the phone. As she is still able to talk through them, I know that I will be able to start my day as planned. She calls me after lunch to say that she has lost a pinkish mucus plug and that she can no longer speak through contractions. I reassure her that everything is going well. At 9 p.m. her husband calls and I can hear her moaning in the background: they want me to meet them at the hospital. We arrive together and the doctor finds her cervix is seven centimeters dilated. She is given a room and she continues to labor well. Her back is hurting and I use St John’s Wort oil to relieve the pain. Her husband is by her side, letting her know that she is doing a great job. She turns to me and says that she needs pain relief. I tell her that this intensity of pain probably means that the baby is almost here. With her next contraction she starts to push. The nurse comes into the room and notices that she is pushing and calls the doctor. As the doctor arrives, it is clear that the lady is pushing and her baby will be born soon. The doctor greets her patient and as the nurse prepares everything on the delivery cart, there is silence and peace as the woman relaxes in between her contractions. As she gets ready to push again, her husband gently wipes her face as he murmurs words of encouragement. I know that with this contraction, the baby will be born. And he is. The doctor tells her patient to reach down to take her child; as she does, her husband bursts into tears. The nurse helps her to place the baby on her chest and covers them both with a warm blanket. I look at the doctor and we smile at each other, happy with the team effort.

Viagra?

I was listening to our national radio the other day in the car. There was a rather lame comedy show that took the place of a mock debate, with canned laughter and all. The debate was supposed to be about the perils of Big Pharma.
With a half an ear on the radio, one eighth of my attention on the road, and the rest of my thoughts on the woman I had just visited, I waited for a laugh - there must be some gags you can get out of the idea of drugs and the common man.
Into my consciousness blurted the voice of a youngish man, explaining the increase in Viagra's popularity over the past few years. In a ham-handed way, he was attempting to turn the problem around, and according to him, the reason why a 65 year old man couldn't get it up was because - oh, when he looks at his wrinkled, saggy, old 65 year old wife, what's there to turn him on?
I quote almost verbatim.
I was shocked. This is national radio! How can he be allowed to present older women, and older men, in such a light? Whoever talks about a long marriage with such disrespect? And how's it anyone's business anyway?
Then I remembered, of course, this is the 21st century. My 9 year old watches hockey games, where men are getting their necks broken by other men (I thought the game was about shooting a puck at a net?), and during the commercial breaks, he learns about Viagra, and imagines it is a pill you take when you are tired of going on walks.
In our drug-happy, Pharma-controlled society, little wonder that women do not expect to give birth without pharmacological pain relief. Men and women cannot maintain a long marriage without Viagra. Children cannot be controlled without Ritalin. For every mild ailment there is a pill. You can take a pill if you are shy, if you are sad, if you are scared.
But why not go through the real emotion? If you look at your old lover's body and see all the scars and lumps that were not there when you met, wouldn't that fill you with love? And if the love isn't Viagra love, so be it.

Volunteer Doulas

Imagine you were alone. Imagine you were new to a country where everything was different - the climate (cold), the language (confusing), the way people act towards each other (are they angry?), the system....
Imagine your country was at war, and imagine that no one in your family could be found.
Imagine, now, that after experiencing violence and abuse at the hands of strangers, that you found yourself pregnant.
We are very lucky, us Canadians. We live in a place where you can have your baby in a safe place, where you can get medical care if you need it, where people have the luxury, the possibility, to help others. And though there are problems, and though we don't all get the birth experience we always dreamed of, we are fortunate.
Montreal Birth Companions accompany women in need through their pregnancy, labor and birth. A volunteer doula will be on call and available for questions day or night, before a woman goes into labor. She will be by the woman's side as she labors, and she will share in the joy when the baby is born.
The Montreal Birth Companions doulas and administrator (yours truly) having been working on a shoestring since 2004. We are dreaming of growing, and for real growth to occur, we need cash.

Dining for Social Change is putting on a gourmet dinner tomorrow night. People will join together to eat good food, have fun, and the proceeds will go towards providing a doula for every woman in need.
I love having things fit together - and this event is one of those times. It is the hormone oxytocin that stimulates the woman's uterus to contract so that the baby can be born. This hormone is also important in breastfeeding. It is called the "love hormone". And it is produced when people are eating together.

So, a toast to all of you! Life, love and happiness to the women we serve, to our volunteers, and to our joyful diners!

Baby Milk

Being one of the bottle-fed generation, I wasn't brought up with an intimate acceptance of breastfeeding. Two years travel in Africa took care of that. In the countries I visited, it was common to see babies and toddlers snacking on milk at all times and in all sorts of places. Women would sit down for a minute, to get a little break from their work, and a toddler would run up for his milk break. A woman would be walking on a path, with a heavy sack on her head, and her small baby nursing from her sling.
Breastfeeding for me was a straightforward event. And for most women, it is, or it should be. Unfortunately, many women who are giving birth in the hospital (reality check: over 90% of North American women) are being educated wrongly about their breasts and breastfeeding and end up having painful difficulties with what could be such an easy and joyous activity.
Most women's breasts are well equipped to produce milk. Some women have nipples that aren't perfect, and some have had surgery that makes it more difficult. But there are a few simple ingredients that make up a happy breastfeeding relationship:
Skin! is one of them. Take your bra off - take your clothes off - take your baby's clothes off!
Remember when you first met your true love? You probably spent a lot of time in bed without any clothes on. That's the way new babies like to relate with their new mothers.
No interference! is another. Forget the bottle, the pump, the soother, the baby equipment. If you want to get breastfeeding off to a good start, you and the baby are all you need. Later, you can play with all the baby toys.
Position! is important. Make sure the baby is taking the breast correctly. Breastfeeding should not hurt for longer than about thirty seconds at the beginning of the feed. If it does, remove the baby and place her on again. Get someone to observe you feeding if you are in pain - and call someone in soon to prevent problems. Call your doula! Do not suffer in silence!

It is such an indescribable feeling, looking down at a fat and happy breastfed baby and knowing that your body helped that child to survive and thrive. Remember that your body created a newborn, and it can create enough milk for that newborn.

This post is dedicated to Luna, who is transcending her limits.

Egypt

I spent time in Egypt years ago, when I felt free to roam where I wanted. We explored the pathways behind the tourist spots and made some good friends during our stay there. It's hard to believe that it is the children of our (then) young Egyptian friends who are now exulting in the possibility of change in their fascinating country. Egypt has a history of great and powerful regimes, great thinkers, and a physical reality based on extremes of sand and water. Whatever happens, it will resonate worldwide.


Change is always painful, though. We humans like stability and we are, most of us, creatures of habit. I have witnessed the change that happens when a new baby enters the world, and although it is an experience full of joy and exhilaration, and power, and love ... it almost always contains an element of pain, sadness, or regret. Ties are broken, new ones are created.



Whatever happens in a country, revolutions, wars, or a long stretch of peace and prosperity, children are always being born, and women continue to give birth. This physical reality never changes.


How we perceive that reality can change, and what we do with it. Are we to continue to suggest to women that the best way to bring a child into the world is to be drugged, to feel no pain, or to have the baby removed like a diseased organ? Or are we going to take hold of an exuberance, the joy of being alive, and recognize that birth is like life, powerful, transcendent, revolutionary.