Fear and Bears

I went to the Rockies over a year ago with my husband. We had a great time, hiking, hanging out and generally enjoying being in the magnificent Rocky Mountains. They are definitely one of the most beautiful and haunting places in our wide world.

I used to go there often when I was a young woman, and the mountains gave me a feeling of peace and confidence I've remembered often throughout my less peaceful life. So I was surprised to hear the many warnings about bear spray: how there were so many bears, how aggressive they've become, and how everyone should be on high alert and carry bear spray.

There are excellent arguments for and against carrying bear spray. 

Arguments For: bears have changed over the decades. Apparently they have gotten much less afraid of humans and perhaps they've become more aggressive, and perhaps the populations have grown. And, why not? It's easy to hook on to your belt and easy to deploy if you need to.

Arguments Against: for decades people have been living, hiking and exploring in the Rocky Mountains and we've always learned that making noise or travelling in groups and following simple rules will avoid nasty incidents with bears. Also, most people obey traffic laws but every so often some poor law-abiding soul gets hits by a car.

I did a very unscientific and completely informal poll on a Facebook group I belong to with over 25,000 members. It's a trail running group, all women. I asked them whether they carried bear spray in bear country, and who had ever had an encounter with a bear. Some of the women had indeed had encounters. No serious ones. Some of the women carry guns. Most of the responses were along the lines that most bears are afraid of humans, and that life itself can be risky.

Life can indeed be risky. Just last week I heard that a bunch of people were forced from their homes by an adjoining state bombing their country. My heart is pretty broken. A maternity hospital was bombed and we know of at least one mother and baby who were killed. How does that make any sense at all? As a midwife, we said brightly to each other "Meconium happens", until a baby actually died and then we realized, yes, the shit actually can and does hit the fan way more often than we would want it to.

But all of this is just begging the question: when is it smart to be afraid and when is it dumb to carry bear spray? Fear is necessary for life: we avoid dangerous things by working through from fear to avoidance to survival. But we can also get too cautious in life, and our fear can prevent us from living our lives properly. 

Balance is the key, but where do we learn how to balance this tightrope, this knife's edge we call life? And how do we teach our children that balance? When part of us only wants to create a soft cushion around the child so they'll feel no pain? Of course we fight against that urge in ourselves, because at the same time we know that humans need to experience richness in their lives, and part of that richness is darkness too. We've all heard the trope about darkness and light. But it's true. As Alan Watts says, if you want the Yang, you gotta take the Yin: more Yin, more Yang. 

Give me those Rocky Mountains, hold the bear spray. No, wait, YOU carry it, I'll skip blindly ahead. 

Now play this song, close your eyes, and remember everything is fine.

  

Cesarean Awareness Month

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

I digress. Let's deconstruct history another way:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Birth 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?

Ask the Doula - epidurals

I am always getting letters, phone calls, or face-to-face questions about birth, doulas, and such.

Every week, I am going to  try to answer and explore a different question that is presented to me, and, in doing so, perhaps answer some of your questions, and perhaps learn a thing or two myself.

Please send me your questions as comments, and I will select one question each week to answer.



Question Number One

"I was at a birth the other day, and the doctor said to my client that there was a recent study done that proves that an early epidural [that is, administered before 4cm] does not lead to a rise in c-sections. What is your opinion on this?"

I think more doulas and women will start to hear about this study, and I think it reflects a dangerous trend. The doctor who quotes recent research seems very with-it and up-to-date - she's done her homework. But let's have a little look at the research in questions:

The study is a systematic review of six studies that included over 15,000 women. Please click here to retrieve it. As you can see, it is a nice little study, I suppose, with one serious flaw that jumps out on first reading.
It states that the ..."review showed no increased risk of caesarean delivery or instrumental vaginal delivery for women receiving early epidural analgesia at cervical dilatation of 3 [c]m or less in comparison with late epidural analgesia." Early epidural analgesia was defined as that administered at 3 cm or less. Late epidural analgesia was not defined, so it could have been administered anywhere from 4 cm well into the pushing phase. Well, when was it? Was it at 4.5? Or was it after an hour and a half of pushing?

The danger is that, the media being the creature it is, someone could simply snip this conclusion, as I have done, and weave a generalization from it. An unsuspecting woman reads the two-sentence generalization and thinks "ahhh, well, that's a relief, I don't have to wait to take my epidural."

Let's look at the reality:
What do we see, as doulas? As I suggest in my book, IF a baby is not optimally positioned (and, by the way, this is also something that we have studied and studied, and we still can't ever really tell when and if a baby is well-positioned, except by watching her  weave successfully down the birth tunnel), and IF a woman takes an epidural early in her labor, and IF the baby's descent could have been helped by a resistant pelvic floor, then this mother and baby could end up with a surgical delivery.

So, in fact, when I see a nice easy birth and:
a mother who has always taken an epidural (and this is her sixth baby and hey! who am I to argue?)
or a mother who always maintained she would ask for pain meds
or a mother who needs meds for another, outstanding reason (sexual abuse being one - we'll get to that another week)
then I have a better feeling about outcome when she decides to take an epidural (even if I know she doesn't really need it).

But when I see a labor that is not going well, for whatever reason: for example, if a woman is having the particular kind of pain that may indicate a poor position, or a woman is undergoing an induction (more about induction coming up too) that looks like it may fail, then I worry about an early epidural, and its effects on labor.

So what can we do about it? "No, little missy, you cannot take the drugs. I as your doula know best"?
Of course not. Maybe there is not really much we can do in the moment. Maybe prenatal education is absolutely paramount. We need to sit with our clients and talk with them about what they are reading, what they understand, what they believe. We need to work with them and open up to them about our own experiences as doulas, and let them know that although a natural birth is definitely simple, it is not usually easy, and that even during labor they will probably have to make choices. And that her choices WILL affect the way her birth unfolds. If she wants a natural birth in a hospital, she will have to work for it. Part of that work will be not accepting pain medication too early in labor.
I know it goes against the review.
But I have evidence that early epidural administration DOES interfere with the normal progress of labor. That evidence comes from my own observation. No studies, no funding, no university degrees. Just women birthing.

Birth and Fear - Advice??

I spoke to a lovely woman this morning who will soon be giving birth. She is afraid.

We talked about that fear. We are all afraid, all of the time. Most of us control ourselves, and only let that fear be felt when we are in extreme situations. Some of us pretend we never feel it. Some of us feel it so intensely, all of the time, that it drives us mad.

I wanted her to know, that as her doula, I would be her companion, at her side,  holding her hand or hugging her tight, or pressing warm compresses on her perineum as she was birthing. But I wanted her to know as well that I was not attached to her birth. That it will be HER birth, just as her life is her life. I will give her my advice prenatally, and share my opinions prenatally, and help her tell her birth story postpartum. But I will not
interfere with her birth experience. I will support her, honor her, and respect her. I will provide her with information and give her a shoulder to lean on and a hand to hold. I will try my best to fill her birthing room with love.

I will let her know that we are all in this large and daunting place together. I am with her, as far and as close as I can be. Then she is on her own, although she will hear my voice as I am telling her she is doing fine. She will move through her birth tunnel and, yes, she will come out the other side. How that tunnel is constructed, what the pictures will be on the wall, no one can say. All we can say, with absolute certainty, is that she WILL give birth, and she will get through it. And it may be very scary. And, yes, very, very rarely (thank you,  modern hygiene and good nutrition), women and babies do not make it. But birth is like life - you never know. The world is big, bright, and round. Babies get born.

World from Above

I was so happy that you all responded to my last post, and I got several more private correspondences about that doula experience. I am opening the floor - What do you do, as a doula, to assist a woman when she is being held by that kind of fear? This woman in particular was quite striking, as she did not appear to have any "reason" for the fear, such as a past traumatic birth.