Trust Birth

What the fuck is that supposed to mean anyway? Trust birth, trust life, trust death. These are all reasonably meaningless utterances.

Let's unpack a little here. 

The phrase came to my attention the other day when I heard through the gossip-vine that someone didn't want me to attend her birth, because I don't "trust birth", because I gave birth in the hospital. I'll start at the bottom of this pile, and we'll move slowly upwards. First, I gave birth in the hospital. Do I feel defensive about this? Well, clearly, yes. Because it's a pedestal upon which those of us who gave birth at home can dance upon and those of us who did it in the hospital can feel ashamed about. Me? I did experience much of the hospital brutality I witnessed as a doula, and then I decided to attend women in their childbearing year so I could facilitate them feeling good about their birth experiences. And I did that, time and time again. Did I experience my own powerful and transformative birthgiving? No. My power and transformation came through small, difficult baby steps.

Does every woman who gave birth in the hospital not "trust birth"? Should she not attend the births of other women, in case she gets scared and fucks things up? Does every woman who gave birth unassisted "trust birth"? Or are things, as so often the case, much more complicated than that? 

Let's break it down even further, and start thinking about the conflict between the medical system of understanding, and the story-based knowledge base that supports out-of-system birth. First, it's looked at as a dichotomy, which isn't true. Some doctors I've had the misfortune to work with in the hospital assume that because I'm a doula and support physiologic birth, I also homeschool my kids, don't vaccinate, and eat raw food. I may or may not, and its none of your fucking business, but we've got a bad habit these days of placing people firmly in airtight boxes. If I've given birth in the hospital, on the other hand, my package is that I give my children too many unnecessary antibiotics and vaccines, send them to school, and buy my clothes at WalMart. 

These are superficial and trivializing examples of a real problem both within and outside of the world of birth. We've decided that everything is either/or, and just as when you're buying internet service, people are seen as "bundles" and not as the intricate, messy, complicated, beautiful creatures they really are.

Now, let's have a look at what giving birth in a hospital actually means. What it actually means is that many, many women go into the hospital trusting that they will be treated with kindness, respect, care. (Are they "trusting birth"?) What often happens is that the people surrounding them in the hospital are coming to birth with a mixed-up, confused, and generally dangerous vision of what actually happens during human childbirth. I won't go into the details right here (but I'm happy to share them another time!) but for various reasons, the perceived risks and dangers of birth far outweigh the actual factual reality, which is that the huge majority of mothers and babies survive childbirth if they are not interfered with. The fear-based approach, however, actually precipitates emergencies, some of which are life-threatening.

Add to that our cultural and societal weirdness that assumes that women are weak (but not all women; the story goes like this: white women are weak and need protecting from themselves. Black women are understood to be very, very strong: so strong, in fact, that when they say something is wrong they are ignored). Add to this toxic soup our inability to accept the Mysteries, and the paradox that is the sexual and divine nature of childbirth and, well, you have a problem.

But not all women who give birth within the hospital system are abused! That's great, right? Oh, wait, but I don't want to hear any stories any more about a woman going in to give birth and ending up with someone else's fingers in their vagina while she is yelling "Please don't, please stop". (Notice she is saying please: we are so polite even in our worst moments). 

So as long as there is just one woman who still has to yell like that, while someone does an unnecessary vaginal exam or a brutal placenta retrieval or a killer fundal massage, I'm still convinced that hospitals are not safe for birthing women. 

And what are the options? Indeed. It is really lovely to be able to give birth in your own home, surrounded by people you love. Many women also want to have a woman present who has some birth wisdom, some experience, some skill. That woman will mostly be silent and invisible, but sometimes she'll peep in and make a suggestions or answer a question. 

Here's the role of a Birth Attendant described so beautifully by Lazarus Lake, who is race director for the Barkely Marathon, which is the most brutal endurance run in the world. The decision to simply witness and not interfere is a tough one, but can lead to so much transformation and joy!

"as a race director you have a responsibility not to let an athlete put theirself in danger.

at the barkley that can be a tough call.

the standing joke is that every barker starting lap 5

would be pulled off the course in any other event.

jasmin was damaged when she left on the third lap.

between 3 and 4 it looked like an open question if she would be able to continue.

but between 4 and 5 she initially looked like a corpse.

she perked up briefly getting her stuff together to start the last loop.

then her stomach rebelled.

watching her try and get things under control to leave i had an internal debate going on.

carl was really in charge

but he was occupied.

and i was supposed to step in and help him when needed.

i couldnt abrogate my responsibilities on a technicality.

so i needed to give the situation serious consideration.

normally it might be advisable to tell her she should get her stomach settled before leaving.

but this wasnt normally.

the clock was running

and every second had counted for a long, long time.

jasmin was not just some ordinary athlete.

she had proven herself many times over.

the weather was not life threatening...

but most of all she was on the verge of a transformative performance.

she deserved to decide the outcome of her race "out there"

so i just watched her head out into the darkness.

the rest of the story the world knows....

or knows most of it.

if you have not been "out there"

your mind cannot create an image of just how hard it is

nor of the sheer horror that is that course.

whatever superlative you went to apply to her performance,

it was better than that."

 "most of all she was on the verge of a transformative...." sometimes it is hard to watch a woman birthing her baby. Sometimes mother and baby need to work through so many challenges. Sometimes we have to step back and let the magic happen, and most of all, we have to trust the woman to decide the outcome of her journey "out there".

"Trusting birth" is another magical language trick that takes the focus away from the powerful woman who is bringing a new human earthside. I don't trust birth, I trust the woman. I trust her to do the work, to birth the baby, to put in the miles, to make her own decisions. 

Sovereign Womanhood and the Misappropriation of Reproduction

We DO have so much power in us. So then how do we end up filing into our hospitals with our birth plans and coming out cut or broken, with a baby in our arms?

All over the world, and especially all over North America, women are finding new ways to birth in their own sovereign power. This can be terrifying. It can be fulfilling. It can be both.

I am speaking to old women who are attending birthing mothers as Traditional Birth Companions. I speak with younger women, mothers of young children themselves, who are devoting their time to attending the births of the women in their communities. I am speaking with women who have said "No!" to the maternity care system we have installed in our countries, and who are giving birth alone or with their families. I see sisters helping sisters. I see communities that are thriving, attending each other in birth, as in life.

Here in Canada, we have very strict regulations about what constitutes someone's right to provide care to a woman during her childbearing year. If you perform any of these restricted practices, without an officially regulated midwifery license, and without being employed by and liable to the health services establishment, then you are practising midwifery without a license.

Billie Harrigan is a Traditional Birth Companion in Ontario. She does not perform restricted practices, and she does not call herself a midwife. She says that Vaginal exams are rude, but also that they constitute a very clear message that our reproductive life and our bodies are not our property: they are the property of the state, and only people mandated by the state can invade them. Number 7 of the Ontario Midwifery Act states that vaginal exams are a restricted practice. In other words, you cannot put "an instrument, hand or finger beyond the labia majora or anal verge during pregnancy, labour and the post-partum period."

Ok, don't get me wrong here. I don't actually WANT to do vaginal exams. I also think they're rude. Not only that, my doula students have heard me say for years that the only reason for so many endless vaginal exams is that medical professionals are not taught about how sexual birth is. The sexuality and the mind-blowingness and the all-out intensity of birth is sublimated into rituals such as vaginal exams (actually, it is absolutely amazing to feel a baby's head in someone's vagina. Just saying. But I keep my hands to myself.)

But my point is, that women have been regulated for far too long. Our bodies have been misappropriated by a maternity system that pretends it is doing things to us for our own good, and it is not. Why do you think many a woman going into the hospital wants (or discovers she needs) a doula by her side? Because the doula can try to prevent some of the grosser abuses from taking place. But not all. And certainly not enough. Not enough to make the difference to so many, many women who feel that they have been violated (and they have!) when all they wanted to do was to give birth to their child.

So, what is happening? Just when the pandemic started making our lives more restricted and difficult, women started wanting to birth away from Covid-infested hospitals. We all, as our lives changed, started to take deep breaths and realize that we don't actually want to go back to the old "normal". I am getting weekly calls and emails from women who want to learn about new ways of birthing. I'm connecting with women around the globe who are moving forward to change the face of birth; to change the world, starting with birth.

Want to come on board? Come along!

“Come, come, whoever you are. 

Wanderer, worshiper, lover of leaving. 

It doesn't matter. 

Ours is not a caravan of despair. 

Come, even if you have broken your vows a thousand times. 

Come, yet again, come, come.” 

Rumi

And, if you are one of us who has indeed experienced trauma, abuse, and despair during your birthing, even more reason for you to move away from that reality, bring your scars and hold your head up high and cry out: "Enough!"

What is to be done?

You can listen to the Baby Magic Podcast for inspiration.

You can join my Traditional Birth Attendant seminar.

You can reach out to me or to any of the fine women on our podcast for community, information, wisdom.

You can reach deep into your womanhood and remember that you are strong! You are magical! I love you!

For those of you who have a legal interest:

Here are the restricted practices in Quebec:
"Any act the purpose of which is to provide the professional care and services required by a woman during normal pregnancy, labour and delivery and to provide a woman and her child with the professional care and services required during the first six weeks of a normal postnatal period constitutes the practice of midwifery. The professional care and services concerned consist in
(1) monitoring and assessing a woman and her child during pregnancy, labour, delivery and the first six weeks of the postnatal period, and include the provision of preventive care and the detection of any abnormal conditions in the woman or child ;
(2) conducting spontaneous deliveries ;
(3) performing an amniotomy, performing and repairing an episiotomy and repairing a first or second degree perineal tear or laceration.


In addition, in an emergency, while awaiting the required medical intervention or in the absence of medical intervention, applying suction, conducting a breech delivery, performing manual placental extraction followed by digital exploration of the uterus or performing resuscitation procedures on the woman or newborn also constitutes the practice of midwifery."
(http://legisquebec.gouv.qc.ca/en/ShowDoc/cs/S-0.1
In Ontario, they are much less vague:


"1. Communicating a diagnosis identifying, as the cause of a woman’s or newborn’s symptoms, a disease or disorder that may be identified from the results of a laboratory or other test or investigation that a member is authorized to order or perform on a woman or a newborn during normal pregnancy, labour and delivery and for up to six weeks post-partum.

2. Managing labour and conducting spontaneous normal vaginal deliveries.

3. Inserting urinary catheters into women.

4. Performing episiotomies and amniotomies and repairing episiotomies and lacerations, not involving the anus, anal sphincter, rectum, urethra and periurethral area.

5. Administering, by injection or inhalation, a substance designated in the regulations.

6. Prescribing drugs designated in the regulations.

7. Putting an instrument, hand or finger beyond the labia majora or anal verge during pregnancy, labour and the post-partum period.

8. Administering suppository drugs designated in the regulations beyond the anal verge during pregnancy, labour and the post-partum period.

9. Taking blood samples from newborns by skin pricking or from persons from veins or by skin pricking.

10. Intubation beyond the larynx of a newborn.

11. Administering a substance by injection or inhalation as provided for in subsection 4.1 (2). 2009, c. 26, s. 16 (1). (https://www.ontario.ca/laws/statute/91m31)"

Belonging and Ur: Thinking about Home

"You finally leave home, the Ur of we, and you find another we? Another place that's just like that, the substitute for that?" *

I know so many people who are drawn to a place. They consider it their home. I've never had that feeling about a place. Yes, I loved the smell of the market in Kampala when I returned 20-odd years later. I'm guessing it stimulated something in my amygdala that my lizard brain appreciated. And I do love the Rockies, as you all know. I love remembering the feeling of being young and fearless, and I love the feeling of recognizing how tiny I am in the bigger scheme of things. Oh, and I love hanging out in my house in Montreal, I love the couch, I love the smell of patchouli in the air from my morning baths. 

But drawn to a place? Having roots, like a tree or whatever? Not for me. I yearned after it for years. I ran to Africa and traipsed around there for a couple of years, trying to imagine myself at home. I joined various communities: the radical feminists, the Left, the Ultra-Orthodox Jews, the underground midwives. I created a large family and I generally feel "at home" when I'm with my kids and their spouses. I always feel at home with my baby grandson!!!

And I always feel at home when I out there running, placing one foot on the ground, then the other, then the exact same thing, over and over and over again, the farther the better. And I feel at home when I'm curled up on my couch, reading a good book. Or when I'm on a trip, going somewhere in a car or a train or a boat or a plane. In the Sahara desert in a truck. In the mountains of Morocco with a young girl who's leading me to a cool mountain stream. 

But I digress. These are all the places I've been ... not really places I actually could call my home, in any true sense of the word. Although maybe .... maybe what I feel is home just ain't what you feel is home. Maybe my wanderlust is deep, so deep that only when I'm moving do I feel "at home". That's why I speak English with a kind-of British accent; French with an Italian accent, Italian with an English accent and a couple of words of Hebrew with a Canadian accent... it's why I can have wonderful conversations with people who I've never met before, and with whom I don't share a language. We use sign language, love, and a willingness to understand and be understood.

I've met many people over the years who have had to flee their homes to settle in a completely new place. I've met families with young children who left a home that was destroyed, who walked for miles only to get on a leaky boat, and if they survived that they walked some more and then had to live in a tents for months and then they could start their new lives in a new country... and they always had their old home in their hearts, even if they knew they would never go back. 

I dream about the house I spent most of my childhood years in. But I don't look back and think "ahhhh, home." But if I just remember a feeling that I had in the back of a truck in Saskatchewan when I was fifteen, and I could feel the wind in my hair and I had no idea what was coming next ... "ahhh, home". Home, for me, is the movement from one place to another. It is never "we". It is always "I" and it can get lonely. I share my home with others - my husband shares it, and my kids and their lovers and my grandson. It's a big tent, but a moveable one. A nomad's home. A snail shell.

When I'm assisting a woman giving birth, one of my many goals is to create a "home" for her, for her baby, and for her circle. I do this in many ways: sometimes with my physical presence, sometimes with my knowledge, sometimes with suggestions for her about choosing her team of support. Giving birth to another human is about one of the biggest transitions a person can make, so if I can facilitate a feeling of being "at home" through that transition, I have done my job well. To clarify, when a woman is "at home" during her birth-giving experience, she feels as if she is at the center of that experience, which is exactly where she actually is. Many maternity situations these days successfully pull a birthing mother away from that center, and away from that home. Whenever she is told that she "should" or "shouldn't" do something; whenever she is made to feel ignorant or foolish; whenever she understands that she hasn't somehow lived up to other peoples' expectations of her, then a birthing woman will feel exiled from her home and pushed out of the center of that primal experience.

And I want to make clear that I am not saying that it's only experiences that are within hospitals, or with OBGYNs that can make a woman an exile in her own birth experience. It's more common within these institutions, for sure, but then again the majority of women now in Canada are giving birth within institutions. I am saying, however, that WHOMEVER and WHENEVER and for WHATEVER reason a birthing mother is spoken to, she must be spoken to with respect, with humility, with honour. There are social media influencers who are shaming women every single minute, with "facts" about her birth choices and her life choices that are just not true. There's a whole world out there full of people who want to drive a birthing woman from her home, by imposing their own personal choices upon her. 

We all need to find a home where we can dwell with some measure of peace. When babies are born in environments of fear or anger, they don't feel that peace. Good things can come from stress and desperation: women who have been torn apart are now trying their very best to repair and heal the birth environment for others to come. I love to do a big huge houseclean every so often: where everything is turned upside-down and cleaned before it is put back in its rightful place. I air everything out, make things smell nice, repair broken things, clean underneath.... maybe we need to do a little housecleaning! 

Please reach out if you want to be part of the new birth attendant course @mbcdoulaschool!

*from Philip Roth's masterpiece The Human Stain. 

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!

The Elusive VBAC

 

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 attendants. One of my favourites is the story of a young woman who had her first daughter by cesarean section. She became pregnant again the same month (yes, I know … but true), 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.

 

Two remarks have stayed with me over the years, and these were both delivered by obstetricians to a labouring woman: “Childbirth is like war, and I am on the front line” is one. “This is Monday morning in a busy hospital. There are road accidents, emergencies…” is the other. This was said to a woman who wanted to labor a little more before going 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 the first man want to become an obstetrician? How did he feel about his “patients”? How had he been born? What was it about birth that gave him images of war? The second remark came from a woman. What was it about birth that frightened her so much? How could the birth of a child be imagined in the same breath as a car accident?

 

What is it about childbirth that makes people think in terms of war, accidents, and death? Is it just fear? And if it is, what exactly is everyone afraid of? And, more importantly, where does the midwife fit into this mosaic of fear, or does she fit in at all?

 

The doctors and midwives who are afraid of childbirth are partly afraid because of their training. Allopathic medicine teaches about pathology rather than about the whole healthy being. In obstetrics, pregnancy is often seen as a pathologic condition that can throw the whole system out of sync.

 

If we look deeper, however, we can see that there is another, more complex root of 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 can this lead to fear?

 

Let me explain. During childbirth there is something present that is outside of us as individuals; outside our knowledge; even outside our experience or our skills. 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, or cut it out another way.

Another thing happens as well. Strangely, your faith (most of us have faith in something) gets turned inwards. As an obstetrician, or as a midwife, you begin to have faith only in your own skill. And that is what is frightening – that an event that cries out for the presence of the Divine (or whatever it is that you would name that) gets reduced to the simply human.

 

I know that there are obstetricians who work 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 do live in sight of that something which many of us name God.

 

But what happens to a sympathetic midwife or physician who is working within the medical system? What happens to her sensitivity to that Other that touches us when we give birth?

 

What do we see in a hospital? We see, first of all, an exaggerated reliance upon technology. The use of technology has a snowballing effect, creating the need for more and more complicated interventions. Secondly, the hospital maintains 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 hospital in labor with my first child, the nurse, who was actually a Scottish midwife, touched my 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 the nurses let me eat and drink less and less, my cervix closed tighter and tighter. I was touched less and I began to feel more and more isolated. Finally, I was only touched when absolutely necessary. The baby’s heartbeat was checked less often. I began to feel abandoned.

 

Our national cesarean section rate is quite a bit higher than the rate suggested by the WHO, which is 10-15%. In Canada overall, the rate is closer to 25%. I’m not interested in exploring why the rate has shot up so precipitously in the past 30 years, leave that to others who love statistics and platitudes. What I am interested in, is threefold:

To create an environment in which every woman has access to a safe and sacred birth.

To provide access to first-time mothers to be able to experience a vaginal birth BEFORE cesarean.

To facilitate VBAC (vaginal birth after cesarean) for women who are seeking that route: to provide information, support, informed choices and LOVE.

 

Here is some advice to midwives, doulas, and physicians who are working with women who want to give birth vaginally after a cesarean:

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 and your co-attendants.

Remember that “failure to progress” means that a woman was probably afraid and stressed. She does not need to be reminded of her failure.

Keep things easy when they get tough. Remember that a woman working for a VBAC will do well in 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.

Tell her you love her. Give her and her partner some time to be alone together during labor.

 

Remember as well, that if she ends up giving birth by cesarean another time, don’t abandon her. Give her the support through the birth and afterwards that you would give to any birthing woman.

 

Birth Witness

Montreal Birth Companions is an organization that serves about sixty women a year. We provide doula services for the poorest of Montreal's women - the refugees, no-status women, and very recent immigrants. We have been active in Montreal for almost ten years, without funding, and without office space. The volunteers are either trained doulas, or doula students, matched carefully with the women they serve.

We have seen our share of disrespect and abuse in the maternity care world here in Montreal, and we are now initiating a project which hopefully will be the beginning of a constructive dialogue.

We are gathering stories from women, which are about instances during their birth experiences where they felt uncomfortable or maltreated. 

We are not out to vilify obstetricians. Our goal is to help to create an environment within which a woman who will be going to the hospital to give birth can be secure that she is treated with respect, whatever her language, colour, marital status, financial level, or whether or not she has healthcare coverage.

We believe that a woman, any woman, has the right to be told what her options are; to be asked permission before she is touched; to be spoken to with respect.

We believe that the attending caregivers, whether they are doulas, midwives, nurses or physicians, have the responsibility to care wisely for their patients. This responsibility includes providing information, asking permission, and exercising cultural sensitivity. 

MBC volunteers have witnessed physicians loudly scolding women without health coverage, as their baby's head is crowning, about their financial mess. I have personally witnessed an OB who made an overtly sexual remark about a vaginal pack. I need to remind residents that it is not okay to rupture a woman's membranes without telling her, just because your hand is in her vagina. I myself pushed my agenda on a woman who was heading for what I considered to be an unnecessary cesarean section, resulting in her feeling betrayed and angry instead of happy about her birth.

We need to talk about this abuse loud and clear. We are not suggesting that every woman in Canada must have a natural birth. We are suggesting that we start to create a system where the woman is at the centre, surrounded by respectful attendants.

Justice

We used to be ridiculously politically incorrect in the olden days. Remember Flip Wilson, dressed in the judge costume, wearing a tilting greyish wig and the "Heah come da judge!" routine?

So, I had to go to court to testify about a case that involved my car and a driver who decided it would be ok to smash into me and then drive off. But two different people (me duh and someone else) got his license plate number. So I toddle down to court on the metro (subway in Montreal), on one of the freezingest cold days of the year, when I'd much rather be at home working on my book (yes, writing another one)...and anyway, the guy had paid his fine and I didn't have to go. They refunded my metro tickets and sent me home.

And I started thinking about justice and how it works.

1. Someone does something bad.
2. They get caught.
3. A group of people decide that the person did indeed do the bad thing, and how the person should be punished.
4. A negotiation starts.
5. Sometimes, justice is done. Sometimes, it isn't.

And I started thinking about the interesting projects I am involved in. I just started helping to organize Montreal's One Billion Rising event. This is a worldwide event that was conceived by Eve Ensler,  to demand an end to violence against women.

This is justice.

Montreal Birth Companions has started a Birth Abuse Witness Program, which will collect attestations from women who have been left uncomfortable with their birth experiences. These attestations are part of a campaign to change the maternity care system in Montreal.

This is justice.

Every week, MBC volunteer doulas assist women who have no resources, who are from other countries, who may not have families or partners here, who may have experienced abuse and violence. MBC doulas accompany these women to give birth and provide a safe and nurturing environment for them and their families during this important time.

This is justice.

At Bumi Sehat, in Bali, women are given quality care during their childbearing year. Midwives, doctors, acupuncturists, and others care for these women without payment because of the generosity of others and their desire to do good.

This is justice.

So, justice isn't only about hit and runs and terrible crimes. When those things happen, yes, we would like the state to get involved and do its thing. But the simple acts of justice, love and kindness balance out. They have to.

Let's find the balance.

Birth Abuse

Birth Abuse. This is a commonly heard term these days in birth circles. What exactly does it mean?

Is it abuse when a woman wants to have a home birth but can't find a midwife because of government regulations, so she ends up compromising on one of the most important decisions in her life, and having her baby in a hospital, lying on her back?

Is it abuse when a woman from another country comes to the hospital in active labor and is spoken to very loudly as if she is a slow-witted child?

Is it abuse when a woman wants to give birth squatting, after a two hour labor, but the doctor insists she lay down, and after the head is born, a shoulder dystocia develops and the doctor pulls so hard on the baby's head that he breaks her collarbone?

Is it abuse when a resident has his hand in a woman's vagina, reaches for the amnihook, and before anyone can say "boo", he breaks her waters?

Is it abuse when a midwife insists that a woman lift her shirt so that she "feels more relaxed" as her baby is being born?

Is it abuse when a doula pushes a woman just a little bit too hard to avoid taking an epidural, and afterwards the woman feels she has been traumatized by the pain?

Is it abuse when a woman is pushing and the doctor stands between her legs and yells at her, demanding to be paid in cash?

Is it abuse when a doctor speaks in a sexual way to a woman who is ecstatic, just after giving birth?

I have witnessed all of these situations, and I believe they all are examples of birth abuse. Yes, some are more shocking than others. Some are definitely in the grey area. But, essentially, abuse in the birth world takes place when there is an absence of respect. Respect is paramount when a baby is being born. The woman who is doing the work of bringing a new life into the world is more deserving of respect than anyone else. But, strangely, in our world, this has been turned on its head. The birthing woman is under everyone else's thumbs, saying "yes" and being a good girl, and agreeing to other people's agendas and priorities.

Is it abuse when a woman goes to the hospital after laboring at home for many hours, and a collective decision is made that this baby needs to be born surgically? NO.

A simple procedure, or surgery, or an interventive test, do not constitute abuse. Abuse takes place when anything is done to a woman against her wishes, or without her agreement. Simple.

Birth abuse is big. Everyone who works with birthing women - doctor, nurse, midwife, doula, anyone - should take a few minutes out of each working day and have a close look at the way they have treated their clients, and if they feel they have not treated the birthing women in their care with the UTMOST respect, then they should make changes.

Birth can be powerful, it can be joyful, it can be frightening and terrible. Birthing women need to be at the centre of everyone's vision so that we can recover an essential balance that we have lost. When women are at the centre of the birthing world, who knows what miracles we will encounter?

Breathe Together

I have had some feedback about the title of my book. Several reviewers have given it "five stars", but have had doubts about reading it because they thought it would be an angry, polemical work about the horror of hospitals and the saintliness of doulas.

And it isn't.

I have a holistic world view, which means that I believe that there is a place for most types of activities and interventions, within very strict limitations. A 90% epidural rate for first-time mothers is just plain wrong. 90% of all first time mothers do not want an epidural, although certainly some do. And very few first-time mothers actually need pain medication. If and when they do, an epidural is a very effective tool that can provide exactly what the doctor ordered.

Cesarean sections are also very, very useful tools. Surgery can save a baby's or a mother's life. But one quarter of mothers and babies in North America are not in danger of dying during childbirth, adn so we see that this tool as well is overused.

We have come to believe that the overuse of these tools is necessary. Women are afraid of pain, men are afraid of birth, and children are being born into bright lights, machines, masked humans, and a mother nowhere in sight.

Here is a little explanation of my use of the word "conspiracy":

The root of “conspiracy” comes from the Latin conspirare, from con- “together with” and -spirare “breathe.” My hope is that just as women instinctively know how to breathe through their contractions, we will realize that we all know how to breathe together. Whether we are in a hospital, a birthing center, or at home, when all of us: physicians, nurses, midwives, obstetricians, doulas, birthing women, partners and, of course, the baby, are working as one in the birthing room, then the birth experience will provide a better start for the new family. When the birthing woman and her child, and not a machine or a chart, or a schedule or an agenda, are the center of our attention, then no matter what the outcome, the new mother will feel better about her experience and will be better able to care for her child. When we simplify our approach to birth, we will see that birth is simple.

Bad Science, Bad Medicine, Bad Luck

I am actually enraged this morning, and I have been since last night. It's just no good any more to pretend to be kind old Mrs Tiggy Winkle, and watch women being abused over, and over, and over again in our worn out medical system.

A few weeks ago, I witnessed a natural, speedy delivery. The woman was effectively pushing in a supported squat. Enter the doctor, who cannot catch a baby from underneath and pressures the woman to lie down. A small shoulder dystocia develops. Doc pulls on the head like there's no tomorrow and breaks the baby's collar bone.

That same week, a foreign lady let me know that an OB at the same hospital has been charging her $100 cash for each prenatal. Here in Canada, that is ILLEGAL.

She labors beautifully, and is almost delivering, when the doc suggests an episiotomy. This was the one thing, the ONE THING, that my client was terrified of. Luckily, she pushed the baby out with the next contraction.

Move forward, random thoughts: A client was in the hospital for twelve hours. During that time, she saw about ten medical professionals. What do you think the most-asked question was: How are you feeling? Nope. "Do you have any questions?" Nope. "Is there anything you need?" Nope. It was "Have you had any miscarriages or abortions. Well, it's not rocket science to figure out that that may not be the best question to ask a laboring woman for two reason: One, she may not want everyone in the room, including her partner, to know. And, Two, these are painful memories that she may not want to think about.

But yesterday takes the cake.

Lady is being induced, medically necessary induction. Gets put on the pit. She's 2 cm. Then in five hours, she's seven cm! And then two hours later, still seven cm! They are talking AROM, so my client wants me to come to the hospital. Fine.

She's laboring so well, not feeling her contractions at all. I have seen this, infrequently, but I've seen it. The doc wants to AROM, but since she's seven cm, she decides to wait it out.

Finally, in the evening, another physician comes in and checks her. She's two.

Discussion. Justification "your vagina is a funny shape". "She's a good resident so we don't check her results". Even when those results are difficult to believe? Really? Then, a peace offering. You stay here and sleep, we'll start the induction again tomorrow.

Bad Science: why the induction? check your results, and especially check a student's results. Have a look at how you're playing with the insulin and oxytocin.
Bad Bedside manner:  Is it necessary that a woman not eat for days? Is it possible to at least make eye contact with the doula, so that she doesn't feel like shit when she leaves the hospital? Are you going to apologize for your mistakes?
Bad Luck:  How often do iatrogenic errors lead to major consequences?

Where is this all leading? It's not leading to a rise in home births, at least not in Quebec. I was speaking to a midwife yesterday from another country who has witnessed over a thousand births, and she is not certified here and therefore is not practicing. There is no bridging program that effectively allows for CPMs to become certified here in Canada, so we are left with a lack of midwives and an overburdened hospital system where errors frequently can and do happen.

Comments? What are YOU doing to change obstetrical care in your community?