Birthing a Marathon?

mile 22

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

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

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

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

Birthing and Running are the Same?

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

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

That's where the similarities end, unfortunately.

Running the Drugs?

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

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

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

Real Emergencies

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

Your Choice?

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

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

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

Birth

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

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

Running

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

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

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

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

Fun Stuff

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

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

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

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

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

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

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!

A Crack in the System

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

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

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

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

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

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

Some questions to ponder:

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

And some mantras to reflect on:

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

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

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

I'm listening!

Mothers, Babies, Chaos

Fifteen years ago, I created a ground breaking, unique, stellar doula course with my colleague Lesley Everest. We wrote and taught a ten-month long program that fully prepared doulas to do their important work, with confidence, respect and knowledge.

Part of that course required the students to do some volunteer work with mothers and babies. Two of our students spent a summer accompanying 14 marginalized women through their late pregnancies, labour and birth, and immediate postpartum period. I was away for the summer, as I always am, and I got back to their stories of difficulties and birth, and new families… and so a seed was planted.

That was the summer of 2004. Over the next couple of years, our students continued to volunteer to accompany marginalized families through the childbearing year, and we became recognized by nurses, social workers, dieticians, physicians, midwives, and families as an important resource for those who had, in some cases, literally nothing.

In 2006 Montreal Birth Companions was “officially” born: it was registered as a charity and we were able to apply for funding (even though we never actually received any!). For the next ten years, until 2016, I matched needy mothers with willing doulas. Over the course of its history, MBC served almost 1000 families. Some of them needed a doula to attend the birth of their child. Some needed resources that we couldn’t provide, so we referred them elsewhere. Some needed prenatal education, postpartum assistance, or caring for older children.

I know that now there is a movement amongst the doula community that says loud and clear that for the work to be “valued” it should not be given away for free (that is, for no money). My answer to that is twofold: the first echoes Chance the Rapper “I sing for freedom, not for free”. The second asks who exactly would accompany these mothers if we didn’t? These were people who did not have an extra dollar to their name. They had no money, little clothing, sparse food and crowded shelter.

We served refugees, refugee claimants, women with no status, domestic workers who had been illegally sent away from their employees homes, young women, women from every different country, religion, background, color … the only things they had in common were that they were pregnant and they were poor. We served mothers who had fled war and destruction; mothers who had fled rape and forced prostitution; mothers who were hiding from their violent partners. We served families who just needed help navigating the foreign medical system. We served women who didn’t know how to call emergency services (no, birth is not an emergency, but a haemorrhage is … and do you know how to dial emergency services in Benin?).

And now you may ask, why? Why did we bother? Surely these families were fortunate enough to be able to attend a modern hospital with dedicated professionals to assist them? Yes, absolutely. The women we served were very fortunate to be able to birth in a safe environment. But for women in an already precarious situation, it is so important for them to give birth with as few interventions as possible. For two reasons: first, the less interventions a mother has, the easier it is to recover after childbirth. If life is already challenging, why not give the new mother the best start possible? Secondly, many of the families we were serving, especially after about 2010, did not have access to our provincial health care coverage. This meant that they would have to pay per treatment. The very cheapest hospital birth cost a new family from five to seven thousand dollars. This would be a birth where they only spent 24 hours in the hospital, and the attending physician didn’t charge too much. The most any of our clients owed when she left the hospital was $39,000. We tried our very best to prevent a new family from having to pay for unnecessary treatments. Once we explained to the medical staff what the situation was, we were usually met with understanding and patience.

In 2016, I experienced the consequences of creating an organization with no structure. My joke was always that MBC (Montreal Birth Companions) stood for Mothers, Babies and Chaos. Basically, my mandate was to provide free doula services for mothers in need. That’s what we did, successfully, for many years. But Star Hawk, in one of her books, describes the frailty and danger of an organization that does not have a clear structure: what can happen is that the members of the organization can start to feel threatened, if not by the leader, then by the lack of structure itself.

Two of my doulas were attending the birth of a refugee woman. Only one doula was allowed in the room at one time (the hospital had a rule that only two support people were allowed, and the preacher from the woman’s church decided to attend the birth). The doulas had not previously met the woman; this was an urgent request from the midwives who were following her, and they had not told me that this person would be there.

Over the course of the labour, the preacher harassed the two doulas with sexually intimidating comments, and finally in the morning he physically assaulted one of them. When the doulas told me, I told the midwives and the clinic, and I was met with a strangely layered response: the man had also harassed a nurse at the clinic, and we should be tolerant because he is from another culture where it is common to act like that. 

This bizarre attitude threw me completely, and left me and “my” doulas with no resources except one person outside the organization who tried to facilitate. I felt guilty; the doulas felt angry and shamed, and none of us knew what to do. Why? Simply, because I had not built an organization that contained within it the structures to be able to deal with unforeseen events. Even if you’re an anarchist, even if you don’t believe in Boards, Presidents, and Secretaries, you have to create some kind of structure that can deal with attack.

So what did I do? I stepped down as director and a collective took over the work and the organization. I was so shaken by what had happened I had to leave the work to others. I withdrew, ran my café, and did a lot of running. In December 2016 I was sitting on the bus and I read a tweet by a Syrian journalist about what was happening in Aleppo. I learned that many families had made the dangerous crossing from Turkey to Greece, where they were being housed in camps.

By January 2017 I had packed my bags and headed to Greece to provide midwifery care to the young families in the camps and elsewhere in Greece. It was one of the coldest winters on record. People were housed in UN tents inside abandoned factories. Some of the more vulnerable were moved to apartments and hotels that were vacant and made available. I met with one family from Syria who were being housed in a small room with water literally dripping down the walls, intermittent electricity, and a shared bathroom. She was almost at term, and her baby was breech, and when I suggested some exercise she said it was too painful because of some bomb shrapnel she still had in her hip.

While the larger NGOs argued over bureaucratic details, such as which organization could visit which hotel, I quietly gathered needed resources (clothes, diapers, soap…) from the over-filled basement of the NGO I was working with, and drove to visit pregnant women all over the north of Greece who were in need. I worked with some amazing, brave people and I will never forget that experience.

But then I got back to Montreal and I was met with a deep weariness. I felt that the tiny drop in the huge ocean of need was never going to be enough. I stopped practising as a doula, knowing that there were younger, better, more enthusiastic doulas out there (many of them trained by myself or my colleague). My extensive knowledge of undisturbed, woman-centered childbirth made it difficult for me to witness many of the hospital births I was called to, and my discomfort spread to others around me. I no longer attended home births, as the definition of “practising midwifery without a license” was at the same time clarified and obfuscated by two different legal battles in Canada.

So, where am I? Well, of course, life goes on, so I have a large family to attend to, a successful café to run with middle son, all sorts of projects in the air … and yet … I was made to serve, and I’m looking for another project, so if anyone needs a CPM without papers (let them expire), doula teacher, or a Jill-of-all-trades to work for freedom, I’m in!

Levatrice....With Woman

Six weeks after I gave birth to the second of my five sons, I was driving our ancient old station wagon back home from dropping off my father-in-law at the airport in Pisa. I was happy. We were heading home to our place in the hills above Florence, where we lived in an old stone farmhouse. My husband taught English and was mostly gone in the evenings. I took care of the little ones and tried to speak Italian.

I remember where we were on the road. I suddenly realized, and I turned to my husband, and said: "I want to be a midwife".

I volunteered with St. John's Ambulance when I was thirteen. I learned everything a young girl could about first aid, and I competed in contests, fake blood and all. I volunteered every Sunday at the Grace Hospital - maternity care, 70's style. The moms were in wards, the babies were behind glass, and the dads could watch them from the hallway. My duty was to take each dad to his proper mom, and to distribute evening snack: apple juice and tea biscuits. I loved it: I loved the new babies, the new mommies, the warm, tea biscuity smell of babies, poop, and women's bodies.

I had a butcher-shop experience at that child's birth: unable to understand the language, I turned to victim mode and suffered uncaring doctors, making jokes over my body; a midwife smoking cigarettes; general anaesthetic, and a baby I didn't even see for over 24 hours.

Midwifery seemed like a good idea.

By 1988, I had enrolled in the Apprentice Academics program. This was distance learning, the good old fashioned way. I read the texts, wrote the assignments, followed my guide, and we sent envelopes and packages back and forth acroos the Atlantic.

By 1991, we had four boys and our small mixed organic farm (complete with large stone house to rebuild - just the two of us....with a little help from our Wwoofers - but that's another story); a large garden, chickens, ducks, geese, a vineyard...life was good! But I still dreamed of midwifery and studied my textbooks at night, collected my Birth Gazettes every month from the postman. I wrote a couple of articles....kept in touch with the lovely women at the Farm.

In 1997 life changed and we ended up in Montreal. I was working as a doula and witnessed many births over the years. These were hospital births.

I am a levatrice - this is the antique Italian word for midwife. I don't use the words "midwife" or "sage-femme", because if I did, I could be accused of practising medicine without a license. But I don't practice medicine. I attend women in childbirth.

I am in the final lap of a years-long process that will end with two exams. When I pass them, I will be able to put the letters "CPM" after my name. Certified Professional Midwife. (Update - I passed my skills exam - only my written to go!)

I teach many young women about how to care for a woman when she is giving birth. These women ask me about the best path to midwifery. There is no best path. My path has been long and interesting, and I am blessed to be able to say that I do what I love.

But at the same time, I am nervous every time I go to a woman's birth. I am excited, and honored, and a little afraid, to be taking part in such a powerful event. And so, I am nervous about my exams. I want to pass, but a little voice inside says that maybe I'm not learned enough.

So, this is the card that was shown to me:

Three of Wands (R) - Learn to be receptive to your needs for a new direction - recognize when your talents, skills and efforts are being wasted. There will be resolution after some struggle - but, much work is still needed. The proper balance has not been obtained because you are preoccupied with your "inner" thoughts to the exclusion of outer advantages. You are actually looking away from the power that is available to you. You have become too giving and this allows others to take advantage of you. You need to check everything before moving ahead. A careless approach can ruin everything. You may experience the failure of some project due to "storms" or problems that are greater than you had anticipated.
You are trying to become involved with the environment after a lengthy time of detachment and reflection which has been disturbed by negative memories. You must be alert to the new opportunities that present themselves and use them wisely. Remain open and receptive to new business ventures and partnerships with reputable people. Be willing to operate from a place of integrity as you move forward - assured in your mind that your heart, mind and spirit are in balance and you are clear on how you wish to handle upcoming situations and the important choices you will be making.
There can be flaws that interfere, keeping dramatic progress on the path just out of reach. The desired qualities for this stage may be present in abundance, but for some reason, the project at hand is off target. Check, possibly right project, wrong motivation or right motivation, wrong project. Guard against over optimism and spiritual vanity as you would against pessimism. Guard against complacency as you would against a nomadic restlessness forever more and more.

I would like to send gratitude to everyone who has accompanied me along this path - and also to invite everyone to a huge party when I finally get that CPM. Maybe that's what it's all for....

Montreal Doula Training April 15, 2012

I am happy to announce that I have teamed up with Jana from Studio Vie to organize a doula course that will be starting on April 15, 2012.

The program is based on the approach that I have explored in my book, and we will be using the book as our text.

This program is comprised of three levels. Completion of the Level One course will allow the participants to volunteer as doulas for Montreal Birth Companions volunteer doula organization.

Level Two is a continuation and an exploration of themes introduced in Level One. This level will provide doulas with the necessary skills to run a private doula practice.



 Level Three courses are specialized, and they take place in all sorts of interesting places.

We will be going to Cuba together next spring, and this summer we will be exploring storytelling and healing with Lewis Mehl-Madrona, in Italy.

To be accepted into Level Three you need to have attended births as a doula or lay midwife, and you need a strong foundation in self-directed learning.

If you are interested in accompanying me on any or all of these journeys, please let me know. Our courses are filling up fast!

More Storytelling - in Lunigiana

The second installation of our storytelling adventure will be in Lunigiana, a hidden corner of Italy where ancient peoples worshipped the moon and carved moon statues, or "menhir".

Lunigiana Storytelling will take place from July 28 to August 4, 2012. We are inviting anyone who is interested in stories, birth, healing, or just plain relaxing and having fun under the Tuscan moon.

Montreal Birth Companions

Right now, a lady who dearly wants to have a natural birth is in labor. She found out about Montreal Birth Companions from a little workshop she attended, and she contacted us with a request for a volunteer doula. She is single, living alone, and doesn't have the means to pay for a private doula - they can run to over $1000 here in Montreal. Of course, many people can afford them because they have private health insurance, and many doulas are now able to provide insurance receipts, which makes it a lot cheaper for the average working couple.

But MBC gets requests from women and families who cannot afford very much at all, and so our dedicated doulas donate their time and energy to accompanying these women on their childbirth journey. Sometimes we are approached by women who can afford a small stipend, but usually we are called by other agencies who have clients who need companions.

Over the years, MBC doulas have accompanied women from the four round corners of the earth: from the continent of Africa, from India and south-east Asia, China, Eastern and Western Europe, Central and South America, and of course from Canada. Our clients speak many different languages, as do the doulas. Many of our clients over the years have not spoken either of the official languages of Quebec (French and English, in case you were wondering...). Many of these women are single, many have recently arrived in Canada, some have left their other children behind.

Today's champion started early labor yesterday. She has been happy at home on her own until this morning, when her contractions started to become more intense. One MBC doula went to her place after she finished work; another is on the way when her work day is finished. They will probably be heading to the hospital soon.

Eight years ago, when our doulas first started volunteering, I was mentoring two exceptional women who were at one of their first birth experiences. This was with a lovely woman from the Indian subcontinent, who was unsure about when to go to the hospital. Although the doulas had been through a very comprehensive training (Holistic Perinatal Associates which, sadly, is no more - it was created by myself and Lesley Everest, of Motherwit fame), they couldn't figure out what exactly was going on, so they made several trips to the hospital in the middle of the night. Each time, they phoned me to ask my advice, and several other times too. So finally at around four am, they called me to say they were off to the hospital. I was lying in bed, and my feet happened to be pointing in the direction of the hospital they were going to. So I sleepily said "I'll point my toes for you.", which meant, of course, the equivalent of crossing my fingers, kissing my amulet, or praying for a good birth. The lady did go on to have a wonderful, natural birth, accompanied by her stout-hearted and exhausted doulas. Since then, "pointing your toes" has become a common saying in the Montreal doula community.

Some of our volunteers relaxing in the hospital!

So, everyone, "point your toes" for the lady in labor, wish her all the best, and let's hear a cheer for her wonderful doulas!!!

Montreal Doula Trainings

MBC volunteer doulas had a potluck meeting the other night, and the subject of doula training came up, as it always does when you get a few doulas together.

Here in Montreal, we have a good selection of opportunities for would-be doulas - but more about that in a minute. First, the whole question of training. We do not need to be trained, any more than doulas are "coaches". One reason why we have to keep using terms that we perhaps don't agree completely with is the grip the internet and its rules has over our choices. "Training" is a keyword that many people will use. Many doula "trainers" will agree with me, this is not an exact description of what we do, but for now, that's the word we agree to use.
Suggestions? Doula guidance? Flaky. Doula program? Could work. Doula course? Too limited.

A good doula training will include teaching, guiding, role-play, hands on experience, and, exceptionally, teaching by example. Usually, the course will have some kind of text, or at least some handouts, to follow; some physical demonstrations; and a role-playing segment where the students can get a sense of what it is really like to assist a birthing woman.

Montreal doula trainings come in two flavors: French, and English. The English programs seem to be few and far between, but most of the would-be doulas here usually find their fit. DONA, the international doula organization, does doula trainings very rarely here, but I have met a few women who have travelled to Ottawa to do their trainings. They cost around $400 for a weekend, and do not include shadowing or mentorship, but do give a good basic foundation. Alternative Naissance also does trainings in English twice a year.

The most well known, and the most comprehensive training in Montreal is the one run by Motherwit. Most of the English speaking doulas in town have graduated, or in the process of working on, this training. It gives the student an excellent preparation for working within the Montreal health care system - which is no easy task! These classes are run two or three times a year, and fill up fast. Mentorship and shadowing is also possible within the program. This is a great course run by a wonderful woman.

I also take on apprentices and run quirky doula courses. I am organizing one in Barbados for the third week of February, in conjunction with the Birth House in Bridgetown.  This summer, in July, I will be teaming up with Lewis Mehl-Madrona to lead a retreat in a fantastic spot in Italy, Casa della Pace. This will be a retreat opportunity for birth workers, writers, and any one interested in healing through story.
I am often approached by would-be doulas for shadowing and apprenticeship possibilities, and I am very open to those. I have four apprentices working with me now, and one in particular is doing a self-directed program using my book as a foundation, in preparation for midwifery training.

If you are interested in any of these possibilities, please email me for further information.

One question the women had the other night was "What if I do the training - and none of them are free! - and then I find out I don't want to be a doula after all"?
My answer is this: "Learn and keep on learning." You will not waste the money and effort doing a good doula program. So much of it prepares you for life, not just for working as a doula. I have learned so much over the years working as a doula that I hope to apply to how I live. Of course, it is important to find the right teacher, and you will know that right away. The choice should be made that way, however, not by price, effort, or convenience. Find a mentor, learn from her. Talk to other doulas. Volunteer. Keep an open mind and an open heart.

Illegal Midwives?

"Illegal" is a word that brings to mind outlaws, bandits, drug runners, hoaxters and jails. I prefer to use the word "underground" when I am talking about the midwives I know who are working outside the (extremely limited) system of registration, colleges,and paperwork that is in place in most of Canada. I joke that they are underground - they'll only assist a woman in an underground parking lot or a basement. Ha ha.

In fact, the women working outside the system are not allowed to assume the title of midwife or sage-femme, which is why many of them describe themselves as birth attendants or even as birth activists. The Montreal Gazette's story about this phenomenon presents some bare facts and portrays a sympathetic, sensible woman who has chosen to assist women who would otherwise be giving birth in a hospital with a doula, or alone at home. Not so say that giving birth with a doula isn't the choice that most women ultimately make. The doula's job is often a difficult one, because of this. She has to straddle compromises that are often unbearable to watch.

"Brave" and "courage" are often words I hear about the women who choose to give birth at home with a qualified, if "illegal", attendant (or "stupid" and "selfish"). But I think a woman is much braver who knows exactly the kind of treatment she may receive in a hospital, after she has already had an unnecessary cesarean section, and chooses to go back into that environment with a doula at her side, in the hopes that she will be able to give birth with dignity and autonomy.

The sad thing is, birth shouldn't have to be about bravery, about ego, about choices, the law, surgery, or drugs.Here is an excerpt from my upcoming book:

The other day I was at a birth. My client was a third-time mother and she didn’t want to be in the hospital for too long, but her previous two births had not been that short. So as she kept in touch during the day I agreed that she didn’t have to rush to the hospital. It was mid-morning when she decided to go, after having a bath and making sure her kids were settled. When the doctor examined her, she was almost ready to give birth. The birth proceeded very quickly, and afterwards, the obstetrician said “Oh, ladies like you will put me out of business!”

I would like to be put out of business. I would like the system to change so much that the privately hired doula is a thing of the past. Certainly, there will always be women who do not have anyone to accompany them at their birth, and for these situations we will have the volunteer doula associations that already exist today. 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 women 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. 

I fully support those women who choose to give birth at home, who choose to assist others at home, and who choose to follow a different path. My only condition, however, is that birth attendants keep their egos, their pride, and their ambitions out of the birthing room, and indeed, out of the process. That way, knowledge of the craft can be the highest priority, assessments can be made honestly, and difficult decisions are not clouded by personal needs.

Two of the most famous midwives, Shifra and Puah, were "illegal"; they disobeyed the Pharoah of Egypt to assist women at home ... power to the women who follow in their footsteps! May we merit to be midwives to a better way of giving birth.

Thank You

I just want to say thank you to all the women who have invited me to attend their births over the past fifteen years. It has been an honor and a pleasure to accompany you through this important time of your life.
And if we only met once when you were in labor, and I rubbed your back but didn't understand your language, thank you. And if I've seen your first child born, and your second, third, fourth, fifth, sixth and seventh, thank you. And if I caught your baby when no one else was around, thank you. And if you gave birth in an hour and a half, thank you. And if I was with you for three days, thank you. And if I held you when you cried, thank you. And if I spoke to you for hours and you birthed in another city, thank you. And if you had a vaginal birth after a surgical one, thank you. And if you had a cesarean to save your baby's life, thank you.
Thank you.