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!

Rest, Recovery, Reflection, Renewal?

I am sitting on a hilltop in northern Italy, rather completely on my own. My dog is here. I'm surrounded by insects, animals (deer, wild boars, the odd wolf, badgers, and all that). I planned for a very active summer, running at least 40 k a week, which I love doing - running long distances is literally my happy place. But then some stuff happened and I got Covid and now I just feel cellularly tired. So every day I spend quite a few hours just sitting staring out at the view. 

And what I've been asking myself is that difficult, age old question: Who Am I?

When you spend hours alone, especially in a spot where silence is the overwhelming sound, you get a chance to really "dig deep" and find out what your questions are. I can't really believe that I have been inhabiting this body and mind and soul I guess for nearly 66 years and I still don't really know who or what I am. So, let me start at the beginning, well maybe not that far back but ... 

Names

I guess you all know the story about how Toni Morrison got her name. Toni she decided on herself, after converting to Catholicism at age 12 and naming herself Anthony. Morrison was her husband's name and she was stuck with it because when her first novel was published she was still using it as her legal name even though they were already divorced. There's an quote floating around from 1992 that goes like this: 

"I am really Chloe Anthony Wofford. That’s who I am. I have been writing under this other person’s name. I write some things now as Chloe Wofford, private things. I regret having called myself Toni Morrison when I published my first novel, The Bluest Eye.”

Well, the same kind of thing happened to me. I'd always been Niki, or Nicky when I was very young. Or Nicola when my parents were mad at me. Then in my forties I had a brush with religion - not Catholicism - and I was persuaded to change my name. So I changed it to Rivka, a name I don't even like that much, but who gets to pick their own name. And then my work as a doula, birth companion, teacher, author and my whole birth persona grew wings under the guise of Rivka Cymbalist and there I was, and here I am, just like Toni Morrison (ha!).

So, for now, Niki is reserved for my family and people who knew me before the Great Name Change. But I'm kind of getting tired of inhabiting two separate lives so I may just change my name again.

Bodies

Who knew? Bodies change. I thought the biggest change would be that infamous time when I grew breasts and got my period. Pregnancy was fun. I didn't have such a tough time with it, in fact I enjoyed growing babies. Birthing them was tough, but I really loved having little babies and children around, and breastfeeding, and those body changes didn't really bother me. Some fibroids, a touch of hyperthyroid. Nothing serious. 

Menopause was kind of a relief, no more monumentally Niagara Falls cycles. No more fertility, and I was ready for that, because I was happy with my five children. Did I think I'd overdone it? No.

But then, the thing is, everyone goes on about menopause because it's when a woman is no longer fertile and I guess biologically speaking no longer useful. But the body changes more dramatically and more quickly after the whole menopause thing is history.

I've written about this before, and I have to point out, it's not specific ailments that bother me - thank goodness - I'm healthy. But just like during puberty and adolescence, and I'm imagining anyone with body dysmorphia, I just don't feel right in my skin. Its like my clothes don't fit me right, except they do. My clothes fit, I still take the same size more or less, a medium. But it's my skin that doesn't fit. It feels weird, it's too loose, it's floppy, it doesn't feel like its mine. I look funny in the mirror, who's that old lady? Why is her skin all dry? damn it, why didn't I wear sunscreen for all those years? 

So that's the tunnel I can fall down when I don't remember to center and use moisturizer every morning. Yes, it is my body, yes indeed I am very grateful and proud of it, it's like an old car, just keeps on chugging. But I can't help it, it feels weird.

Profession

Oh goodness, could I just say I'm a witch? I guess not....but this is weird too because I think I studied witchery and magic my whole life, and science too of course. And poetry, and of course I learned all about having kids and all when I went ahead and had five of them. 

But my professional label doesn't exist, because I'm not a registered midwife. I'm a birth companion or whatever. My Impostor Syndrome kicks in frequently; sometimes I think my actual profession is "Impostor".

I've mostly been a mother. 

And the renewal part of this whole exploration? It's a deep, deep sense that change means pain, and from pain comes change. Life just doesn't stop, until it does. So, in a sense, my resting, my recovery, my reflections ... lead to a renewal of sorts which is a kind of an acceptance of the continually changing nature of my life: child, young woman, mother, older woman, mother, older woman, grandmother, mother, birth attendant, peace keeper, rebel, anarchist, runner, crone...

Shields, magic, bubbles, screens

 

One of the key qualities that a doula or a midwife seeks to make use of during her journey with a woman as she births is the ability to create shields, bubbles and screens. This quality is akin to magic, and it is hard to access and even harder to use skilfully. 

1. Shields can help prevent a birth attendant from bringing her own baggage to the birth room. To do this, we must place the birthing mother at the very center of the experience, so much so that our own desires, opinions, concerns, and emotional reactions do not really matter. At the same time, we must be constantly aware of the health and well-being of the mother and child, but not in an emotionally infused way. Rather, we have to notice what is happening, much like a Buddhist will notice emotions as they drift past during meditation.

2. Bubbles are wonderfully useful and I made so many of them when I was working as a doula in the hospital setting! A bubble is a protective sphere around the birthing woman. It can include her partner, you as the birth attendant, her midwife, her mother or whomever, but its main purpose is to maintain an emotional or spiritual "space" within which the birthing mother can find her way. Often the woman giving birth has other people's ideas and opinions floating around in her head, which can detract from the intensity of what she needs to do. The bubble will often give her the chance to be fully aware of what her body is doing, so that she can stop thinking through the event.

I will create a bubble by visualizing, but also with physical closeness to the woman (eye to eye contact, light massage), and also with carefully chosen words and a physical distancing (turning my back) from the people outside the bubble. Sometimes it will be necessary for the woman to move to a different room in order to fully accept and embrace the bubble.

3. Screens are effective when there is a danger of you, the birth attendant, becoming emotionally engaged with another person in the birth room. You must erect a mental screen so that your exchange with the other person doesn't infect the atmosphere in the room. For example, if the birth is taking place in a hospital and the nurse is feeling lonely and wants to chat about the patient in the next room, I always like to erect a friendly screen so that the nurse doesn't feel rejected but she knows that conversation isn't appropriate. On the other hand, if a member of the staff is being abusive to the birthing woman I will erect a very strong, impenetrable screen that shields the birthing mother and her family from the anger or ugliness that is taking place. This can be very difficult.

These methods can be used outside of the birth room as well, in stressful situations in all walks of life. Just get your magic on, and you can create a peaceful dwelling for yourself and those around you.

Grateful for Dogs?

Even though I have a punk-rocker scar on my head where no hair grows from being bit by Skippy when I was a year and a half and I though it was my ball but clearly he thought it was his - and he paid dearly for his mistake! But anyway, even though that, and a huge scar my mother always had on her elbow from a badly trained guard dog in Uganda, even though these bad dogs bit us, I am now very grateful for dogs and in particular for Stella pictured above. She has taught me about unconditional love, playing, guilt, and determination.

Ok, there we go. So I'm grateful for D for Dogs.

But what I really wanted to talk about was D for Dreams. How we are molded and folded and ultimately completely remade by our dreams. How our dreams make us what we are and in turn we remake our dreams to fit the new person that arises whenever a dream turns sour or gets different, as dreams do.

My first dream: I wanted to dance forever on the sand, wearing little clothing and having the constant presence of my Ayah who loved me (but of course now I realize that she must have had a whole other life and that her caring for me and loving me was only part of the colonial myth that my parents were living).

My second dream: After getting yanked from Uganda to Calgary where it snowed and people wore a lot of clothes, I had a dream. My dream was to be an astronaut. I studied the planets and the stars, bought a telescope, kept a journal where I marked the positions of the stars, built model rockets, and made a small spaceship in my closet where I would head off to space every so often.

My third dream: Adolescence is a bitch. I realized life was hard and no one really knew the truth. I decided it would be a good idea to change the world. I thought I would like to be a doctor.

Then, things went crazy, life intervened, I travelled, had babies, married, and decided I wanted to accompany women in childbirth.

My Birth Dream: 

I studied midwifery and obtained my Certified Professional Midwife qualification. I started studying in 1988, when I was pregnant with my third son. I continued my distance studies for ten years, and then started working as a doula. In 2004 I started the CPM program, and in 2014 just after my mother died, I passed my final exam and became a professional midwife.

Yay!

Except ... except that I had miscalculated and I hadn't really grasped the reality of having a CPM qualification in Canada, where legislation requires midwives to be university trained in order to be licensed in order to work legally.

And now here's the big question: who wants to work illegally as a midwife? If midwifery is actually illegal, you can hone your skills and use your technologies such. as they are (Pinard horn, fetoscope, doppler, palpation, suturing skills, episiotomy if necessary, cord cutting and the like), and then if you really need to, there's always the hospital where you can pretend to be the birthing woman's friend.

But in a situation where midwifery actually is legal but restricted, that makes it much harder for anyone to actually monitor a mother and baby when things start to move outside of the norm. And, despite all sorts of people's convictions, I believe there is a norm that birth usually happens within. There's a certain time span when the woman feels certain things, when baby descends and then emerges. Within that norm, there's a ton of variation, and within that norm there's no need for intervention at all. But when things stretch outside of the normal, that's when the restrictions become dangerous and that's when our hands are tied. Because there are always women, and even more so now that Covid restrictions have made homebirth even harder, there are always women who want to birth their way, in their own home, with whomever they want present. And they call me to ask if I will be their "fly on the wall" in case something happens.

What? How can I fly do anything if the shit's hitting the fan? Granted, shit doesn't tend to unfold at a normal birth.... well of course meconium happens sometimes and mamas poop... but that's not what women are asking me to do.

Let's just use logic here: 

1. First, let's remember that the original "concept" of the modern doula was the result of a flawed study on maternal-infant bonding. One of the researchers had provided verbal support to the mothers she was observing, and those mothers had quicker and easier labours. So I guess if a mother is planning a "fly on the wall" kind of birth and she wants someone present to encourage and reassure, then she might want to hire a doula
2. What shit might hit the fan? What are women afraid of? I've asked women and they tell me they're afraid of hemorrhage, of the cord being around the baby's neck, and of something happening with the placenta. Partners are afraid the mother and baby will die. But if a woman is actually worried about these things, why would she place her trust in someone who is actually not allowed to do anything about it? Or does she think that her perfect birth is worth that other woman's livelihood, marriage, and possibly her home?
3. The unassisted births I've heard about either before or afterwards are those where the mother and her partners decided to give birth either on their own or with select family or with a doula present. NOT with a trained by handcuffed birth attendant. 

There are tough choices to be made, all the time, in the land of the living. I myself always seem to be figuring out exactly how to live on a knife's edge. Yes, I provide prenatal guidance and support. Yes, I have been a "fly on the wall". Yes, I train doulas to accompany mothers to the hospital. Yes, I will tell you that I believe you should call your doctor, or get to a hospital, if I think that is right. No, I don't believe that nature is particularly gentle. No, I don't trust women's bodies. Not after millenia of patriarchy have inflicted deep, deep wounds on our abilities to recognize when it's right and when it's wrong. 

Would I risk everything for a birthing woman? I have and I will. But not for random shit that's hitting a fan that we ourselves turned on. 

Today, I am grateful for Dogs.

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!

Meconium Happens

The more I live this life, the more I am convinced that the deal is, it is not what happens to you that matters so much, it's how you accept it (or not). I have been to births that have been really challenging and tough, where the woman accepts the labor and is thrilled with the whole experience. I have seen other women fight against labor and birth, one contraction at a time.

Today is December 6, 2020. A day like any other. Except not: it's the anniversary of the day when 14 women were killed by an armed killer.

It's a day when my friend had to go back into hospital. It's a day when thousands of people died from Covid-19.

It's a day when we have to, as always, take the joy from every moment and cherish it. And even when we are full of joy, and all comfy in our enlightenment and entitlement, shit will happen. Meconium does happen. A baby can suffer some small slight and poop. Or a baby can get their cord squeezed so much they poop a lot. Things break down, things break. People break. 

But where there's rupture, there's repair. A body's urge is to health, just as a plant moves towards the light. In the same way, the knowledge of women has always been towards healing. 

We can't do anything to bring those women back to life. But we can speak out against violence every single day. And, unfortunately, in my field (haha no, not in my cafe...in my real field which is maternity care), violence against women is rampant, ugly, and expected. 

What can be done? Well, one thing that's happening is that pregnant women are rising up and saying "No more violence! No more treating me like I'm a child, that I don't have feelings, that I don't know my own body. No more speaking about me as though I'm not present. No more making decisions about my body without my consent. No more doing things to my body without my consent. No more lying to me!" And how are these women doing that? By withdrawing from the hospital system. They are giving birth on their own or with Traditional Birth Companions. 

Another thing that is happening is that doulas are continuing to support women who choose to give birth in the hospital. Or, more importantly, those women who don't actually have the choice and have to give birth in the hospital. Especially these days, it's hard to be a doula. Many hospitals have taken away the birthing woman's right to support by insisting that she choose between her partner and her doula. So doulas are providing companionship and support virtually. 

Medical staff in hospitals in today's world are stressed. They're overworked, tired, and they have all the same concerns on their minds as you or I. Suicide rates are higher for physicians than for the general population, and higher for female doctors than males. The medical system isn't working for anyone.

What can a doula do to relieve everyone's symptoms? Let me be clear: when a doula works to facilitate a mother feeling empowered in a situation where her power can be taken away from her at any minute, we are not talking about getting at the root of the problem. If a birth is an undisturbed birth in a place where the birthing woman is comfortable, safe, and respected, then the doula can do the work of being a doula: easing labour, providing encouragement, seeing to the birthing woman and her family's needs. But if a birth is taking place in an environment where the go-to routine is medication, management and directives then the doula can only provide bandaid measures within a strict and abusive system.

And these bandaid measures can work! Any number of women leave the hospital with their babies feeling joyful, even ecstatic, and satisfied with their care. But a huge number of women leave the hospital hurting.

Is it time to finally step away from an abusive system? What happens to a woman when she has a vision of a natural, normal birth and she arrives at the hospital and things start to go haywire? Is it possible to convince women to stay at home, at least until they are in active labor? What about the woman who feels every contraction, from the very beginning, like torture; the woman who can't separate her labor contractions from an abuse she experienced years ago? What is the role of the doula through this seismic change? What about midwives? Why are midwives still using the words "should" and "allow" when they speak about birth? 

Is it time to Rise Up?

Birth and Scars

As we grow, we absorb big and small shocks to our bodies and souls. We all know where our physical scars are, and we often assign stories to them. I remember when I was skipping school and the knife chose that day to slice my finger, so I had to get myself stitched up without (I dreamed) my mother finding out. I have a little white line on my finger that tells that story.

Some women have bigger scars, on their skin and their muscles, from birthing their babies. I hear these stories often when I am speaking to women about their birth experiences.

Other women have emotional scars that last for years. These scars have a way of aching and burning during pregnancy and birth. The doula can gently assist the woman when she is feeling these aches and pains. Doulas are not therapists so they do not have to probe, suggest, or hypnotize. What they do is provide a non-judgmental ear, if the woman wants to talk. They let her know that she is not alone, that she has support. They also remind her that there are other women who have traveled the same road and survived.

One of my students is accompanying a woman as I write. The woman has been in labor for most of last night and today. She does have emotional scars, and they are hurting. My student has been with her the whole time, supporting and comforting. And even though my student is a very inexperienced doula, she is still providing the essence of what a birthing woman needs. The expertise, medical know-how and scientific facts is not the realm of the doula. She is there with other skills: the skill of touch, listening, compassion, and presence.

With our world changing every day; with our experiences and our innate wisdom challenged every single day; with our routines and habits changing minute to minute, we are starting to see between the lines of our lives. We are starting to look between the cracks; to probe between the layers of darkness that we have been hiding behind. We, as women, are starting to see what has been hidden: that birth is a unique act, unique to women; that women's bodies are exquisitely designed for this task; that a woman births best when she is surrounded by a loving circle of care.

It is wonderful if that circle of care can include someone, an elder perhaps. who know about the vagaries of Mother Nature and her cruel jokes. But if not, chances are that everything will work out fine. And that is better than being treated like a child, when you are bringing forth new life.

So I see women and their partners and their communities going about their lives, far from hospitals and Covid regulations. And it makes me sad that with this huge machinery of health care that we as a society couldn't have created a safe and sacred space for women to birth in; but I understand why that isn't possible. Can you imagine what would happen if the power of womanhood was actually unleashed? 

Think about the biggest wave you've ever seen. Think about the most love you've ever felt. And the most beautiful place you've ever been. Imagine what it would be like if women grew babies in their wombs and birthed them with respect, honour, and love. 

Scars have a way of healing. With healing comes change, and growth. Womanhood has been injured and scarred for too long. There's a new era coming, so watch out!

Birthing in Love with MBC Radical Doulas

"attending a birth is a political act"

Montreal Birth Companions 

radical doula organization

In 2003, I started a doula training program with my then business partner, Lesley Everest. Over the first year, I realized that our volunteer requirement had the potential to change the lives of women, and I founded Montreal Birth Companions. During the summer of 2003, two of our first doula course graduates attended 14 births. These doulas accompanied women to the hospital to give birth throughout that first summer, without any compensation except the experience and the knowledge that they were honoured guests of the families that were bringing a new life into the world. Montreal Birth Companions, or MBC as it affectionately came to be called, was a radical, unique, inspiring organization that survived for 13 years because of the power and love of the women who served there. We never got funding, although occasionally a private client would give us an extra bit of money and one of our hard-working doulas would get a small stipend. Over the years, we served hundreds of families who would never have been able to afford doula care if we had not provided it. We accompanied many women who were completely alone, and others whose partners needed to stay home to care for other children, or who needed to work. As time passed, we started to gain recognition in the non-status communities and we served many, many women who were living without legal immigration status, and hence without health insurance. It was essential for these women to have the support and guidance of a doula, so they could give birth with as little intervention as possible and thus avoid huge charges (our most expensive birth was $30,000, which was the culmination of an induction, several days in labor, an epidural and various other interventions and medications. Of course this money couldn’t be paid up front, and the woman spent months trying to pay it back.) MBC fell apart in 2016, after some internal arguments about political views. It turned out that some of the doulas wanted a traditional organization with a board, meetings and all that. My view was always that the only mandate was to provide free doula service to marginalized families in need. So what was the need for having meetings or creating unnecessary structure? Well, it turned out, the need for structure is so that if a crisis occurs, you have a predesigned way to deal with it. Starhawk talks about this in her book Truth or Dare, where she explores all sorts of things, anarchist organizations being one of the oxymorons she shines a light on. Because when two of our doulas were sexually assaulted by one of our client’s “friends”, we had no structure to deal with the fallout; no one person who was in charge of crises; no list of things to do. And so I took it all on, and decided that I had failed everyone, and I stepped down. But now, looking back, I realize that it was an amazing moment in history! We accompanied women to have their babies in love, with companionship, within a circle of care and held space that they would not have had otherwise. We did this out of pure love, a dedication to women, a desire to give the marginalized folk amongst us the same basic rights (yes, having a circle of caring women around you when you give birth is a right!) that we affluent women do. We did all this without money or financial support from anyone, which gave us the freedom to do what we needed to do. It was a fine time, and I am still getting calls from women without health care who are seeking that support. I spoke recently with Julia Gordon, who was one of our volunteers, about what it meant to be part of such a life-changing, radical group of women. Here is our chat:

Baby Magic Montreal Birth Companions

Raise Love Consciousness with Maha Al Musa

When I asked Maha to give me one word to share her message with the world, she gave me three. Raise Love Consciousness.

I was thrilled to have a couple of hours chatting with Maha about childbirth, consciousness, sovereignty, feminism, bellydancing and her work liberating childbirth, women and babies.

You can reach her on Instagram, Facebook, or check out her website. 

Are you pregnant and looking for a guide to uncover your inner power? Are you a Birth Keeper who wants to learn more? Maha's unique birth preparation program is for pregnant mums who innately know that giving birth is meant to be a sacred, instinctual and an embodied experience and who are seeking an immersive and expansive experience as they flow through their 9 month journey. It is also for birth keepers wanting to reframe birth's purpose, be inspired by a view of birth that will raise human consciousness and understanding the journey from a sacred, wise lens to share with mums-to-be.

I am so honored to have the chance to speak with powerful BirthKeepers, Educators, Mothers, Artiists, Rebels ... Baby Magic is magical!

The End of Midwifery

A Heavy Heart

My heart is heavy. Guess what guys? The Man won! It's the end of midwifery! Ok, probably not really. There's always movement and change. I guess the brave families who decide to birth at home on their own will engender the new wave of fearless midwives. I hate it when polemics are forced upon you though.

Ok, I will stop speaking in tongues and get to the point.

I can't believe it's been two years since the crackdown. Actually ... yes, two years. In October, 2016, in two Canadian provinces, three women were charged with "practising midwifery without a licence". Also, just under two years that independent midwives in the UK (fully trained and registered as midwives but choosing not to work through the National Health Service) were forced out of work with a legislation that passed in January, 2017 that meant that they needed to find private indemnity insurance in order to take on clients. And in Hungary, professional midwife Agnes Gereb was sentenced to two years in prison for practising midwifery.

Satanic Brain Surgeons?

What does all this mean? Is it similar to a satanic team of brain surgeons who trained at woodworking school and decided to give everyone down-home lobotomies?

Nope. It's a question of what happens with regulations and legislations. It engenders all sorts of divisive tactics and means that the powers that be, i.e. the legislators, have to keep things steady by creating divisions between people.

It was the midwives' associations that took unregistered midwives to court. That same organization was born during the slow process to legalization of midwifery, back when all Canadian midwives were working "illegally": the work itself was deemed illegal. So how could those women have retained their memories of their own actions and still thought it appropriate to condemn others doing the same?

How did The Man win?

Well, it was actually we who lost. We've created an illusory community based on love, trust, love and peace and all that stuff. We talk about safety, honor, respect, inclusivity, but in the end it all disappears in a puff of smoke when push comes to shove. Which it does.

I've travelled the world; created vibrant and useful volunteer organizations (Montreal Birth Companions and WWOOFItalia), and left them; I've been an organic farmer, a midwife, a doula, a teacher. I left that work and now I own and run a small cafe. I'm hiding from the world, I've created a space where at any given time I have a couple of breastfeeding mums sitting n the couch chatting; a lineup of working people getting their lunch; a few retired couples or groups of friends; the constant stream of coffee drinkers working on their laptops. I serve wholesome home made food. I've withdrawn from the birth world, and from the volunteer world, with all of the broken trust and betrayals that both those worlds offer.

What do you mean, betrayals?

I witnessed two NGOs fighting over turf: refugees caught in the middle. Warehouses full of clothing, diapers, and other donated items laying abandoned as not-for-profit enterprises argued over who was to deliver which items where. What levels of insanity are at work here? I was sneaking baby clothes and diapers from the basement of an NGO to take them to a woman in need who wasn't registered with them.

Two volunteer doulas were sexually intimidated, one of them physically, while they were attending the birth of an asylum seeker. Her bible-toting "friend" assaulted one in an elevator and made crude remarks throughout the labor. The response of the aid organization to the complaint? "It's their culture: it's our job to tolerate and teach." What levels of insanity are at work here? Racism: the Nigerian men are all rapists? Sexism: the women's job is to submit and teach by example? Classism: y'all are just volunteers; we are salaried midwives/bureaucrats and our word counts.

I witnessed a 60 year old midwife who was a fully trained professional break down in tears when she read that her government would no longer allow her to practice midwifery. What levels of insanity? Insurance schemes, corporate health care, pitting woman against woman. The end of midwifery.

And on a teensy but frightening personal level, I witnessed a disgruntled doula wreak havoc online by accusing his elders and publicly shaming them.

Culture in Full Decline

We in the affluent world are witnessing a culture in full decline. There are many signs; just look around you. We live in a culture based on fear and suspicion, when there is really very little to fear. The culture abounds with cheap goods made in sweat shops staffed with children who should be in school. The biggest problem of our age is the refugee crisis; xenophobic leaders are being voted in all over the western world because the left has made a caricature of itself. We can buy pot in little plastic child-proof containers; midwifery is tightly regulated; everyone is afraid of each other with no reason; language has been turned inside out. The end of midwifery.

This is where beauty lies.

Real midwives take risks. Real midwives love each other. Real midwives support women. Real midwives can take no for an answer. Real midwives are tolerant. Real midwives know when their skills are not enough. Real midwives are afraid sometimes, but they don't allow their fear to guide them.

For some real midwifery, have a look here, or here. Write to me if you want to know more.

Sending out love on this gibbous moon waning.

Pyrrhic Victory

Last night I attended my last birth for a long time, unless one of my special people asks me over to attend her birth - and you know who you are my loves!

I was working in my capacity as a doula - to my utmost capacity - I calmly stood by while the staff dickered around about whether the meconium was thick or light. I kept a grin off my face when the young medical student estimated that the birthing woman, who was clearly very close to pushing, was "progressing nicely" at six centimeters, and I kept calm when five minutes later she started pushing in earnest. I kept the worried look off my face when it appeared that there might be an abruption, and I supported the nurse while she tried to do her job.

I supported the woman, I supported her husband and her mother. I kept my face devoid of grumpy callouts when staff acted unprofessionally. I pandered to the two young doctors, and praised the Big Doctor Man when my client asked me, in front of him, if he was "good". In short, I brown-nosed the way doulas learn to do in our maternity care system.

The doula's job is to support the birthing family, to bring love into the birthing room, to create a safe space.

So imagine my conundrum when the nurse asked my client if she agreed to erythromycin ointment for the baby's eyes. My client didn't know what to say, so she turned to me for support.
I had to think quickly. I could site the most recent statement by the Canadian Pediatric Society, (http://www.cps.ca/en/documents/position/ophthalmia-neonatorum), which suggests eliminating the practice of universal antibiotic prophylaxis for neonatal eye infections (most dangerously caused by gonorrhea or chlamydia), or I could avoid looking like a know-it-all and making the doctor feel like a fool, and simply use a tactic that I had seen him use a few years ago (something about his wife, can't remember the details).

What to do? Think fast! It's three am and your client wants an answer. She then asked me "Did you give it to your kids?".  An honest answer - yes, I did.

Pipes up the honourable physician, to the effect that my client shouldn't be so stupid as to agree to an intervention just because "someone" had it done to her kids, but rather should have it done because "doctors advise it". Um. We were all rendered rather voiceless. Then, again, Dr. A. pipes up: "Will you vaccinate your child?" My client answers that, yes, of course she will.

Intimation being that I wouldn't vaccinate my kids, and would advise my clients not to. So rude! So judgemental! So many unfounded assumptions! So disrespectful of the birth room!

It makes me sad that people that are supposed to be practicing good medicine, and good science, are practicing mediocre medicine, not reading the literature, and showing off their skills at making an older woman feel like shit at three in the morning. Bravo! Physician, heal thyself!

 

Salut Pauline! Loving my adopted province!

Last week, Montreal Birth Companions assisted a woman to give birth. Her hospital stay was very long and she finally left with a bill of over $20,000.

She was one of the many women MBC assists who do not have medical coverage here, who give birth in our hospitals at great cost. Some of these women are domestics who have been fired by their employers. Some are women who are here on the wrong kind of visa to be pregnant (hey, Harper! I thought you were against abortion!). Some are here illegally because they are afraid of harm or death in their home countries, but they do not qualify as refugees.

This woman was the kind of Muslim that Madame Marois wants: modern, educated, no head scarf. Her reasons for fleeing her country were valid and I will not explain more. She was taken in by an elderly Anglophone woman until the baby was born.

She needed a place to live, so we finally found her somewhere to stay until she gets on her feet. She is employable and will be fine.

But - her birth and postpartum search for housing was such a typical Quebecois event! The new mother was a Muslim. She wears western clothing and no head scarf. She was taken in by a Quebecois Anglophone, who is very old and appeared to wear a dressing gown. Her doula was a Quebecois Francophone who is a political activist. She rides her bicycle most days and has a couple of piercings. Her second doula was also Quebecois, who is a member of the Canadian army. The mentor doula is a Jewish woman whose politics veer from left to anarchist. She wears a headscarf. The shelter where she finally found refuge is run by a Muslim woman from Malaysia who regularly provides food for one hundred people at a nearby church. She wears a hijab and a floor length gown. The journalist who was interested in the story is a member of a visible minority. We all spoke different languages: French, English, Arabic, Bahasa Malaysia, Italian... and probably more...

We are united by love and goodwill, and by the urge to change this world for the better. Some of us wear head coverings, some of us don't. Some of us believe in God, some might not. But this Quebec is the place I like living - where we all get by and get along, sometimes speaking in broken this or that, trying to get along because we believe that getting along is a good thing. It's the place I brought my kids so they would get an education, and they are getting an education, and they speak several languages, including the language of tolerance.

So, Pauline, even though you have a bunch of liberal feminists on your side, and some aging would-be politicians, I would like you to come and visit our Quebec: the Quebec where we help people who don't necessarily believe in the same things we believe in, or speak the same language as we do, or wear the same clothes as we do. And I would like to remind you that while you are doing your politics, babies are being born and friends are being made and bonds are being formed across all of your artificially constructed boundaries.

A Student Doula's Story

Here is a post from another blog by one of my Level One students … giving you an inside view of what it's like to be a student doula, volunteering for Montreal Birth Companions.

DEAR BIRTHING, WITH LOVE (thank you http://highalert.net/news/dear-birthing-love)

I am ready to stop typing and run to my phone if it rings. It may be a call from the doula I’m shadowing. There is a woman who will give birth any day now, and when this woman (the client/patient/mother-to-be*) needs birth support, I will go (with the doula) to be with her at her home, or maybe straight to the hospital.

Besides my own, the only birth I’ve attended was that of my little sister, and I was a 5 year-old, and it was late at night. This makes me a minority among the 16 women in my Level 1 doula training course with the Montreal Birth Companions, because I am not a mother.

You don’t have to be a mother to be a doula. You just have to be there. In the last few months of this course, I’ve learned a lot about birth: anatomy, pain-alleviation techniques, how it progresses and why it might stall, affirmations, visualizations, and what to pack in my birth bag. This is all important, but the most important role that a doula plays is of being present, and being loving.

Montreal Birth Companions, then, love hundreds of women a year. They provide free doula services to women in need. They are most often refugees, immigrants, women without family in Canada, and women who don’t have health care. They are women who just need a little bit of love at a vulnerable time.

With each ‘birth story’ that I hear from a fellow Montreal Birth Companion, I am filled with admiration at the important role they play at these births. They are advocates and peace-makers, negotiators and videographers, a friend and calm presence. I am also filled with a certain amount of frustration or anger at a medical system that seems, often, to desecrate such a powerful moment—perhaps the most powerful of all. Birth also has two sides: pleasure and pain. But, I’ve learned that pain in birth serves a function—it releases oxytocin which makes the contractions stronger and more effective, and stress hormones increase blood flow, which brings much-needed oxygen to the baby. I’m not confident, though, that the ‘pain’ of the medical system serves a purpose.

I’ll remain on high alert for calls to explore birth and love in the hospital. In the meantime, I encourage you to VOTE daily for Montreal Birth Companion’s campaign to provide more free pre-natal classes to women. You can like the MBC’s facebook page and select 'get notifications' for daily reminders.

*Serving as a doula is new to me and I am not sure what language I feel comfortable with, yet. As my teacher writes in her book The Birth Conspiracy, 'client' seems impersonal and business-like, while 'patient' may disempower the woman giving birth.

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....

Trust Birth?

I read a post on the ubiquitous Facebook the other day about a triumphant birth. A woman and her husband went to the hospital with their doula. The woman laboured with the support of those around her - her doula, husband, and the medical staff. She required no drugs, no medical interventions at all. In fact, she had a natural birth in a hospital setting. Which is wonderful, joyful, and, unfortunately, increasingly rare.

Why did she have a natural birth? Was she lucky? Did she just happen to have the right combination of a good pelvis, an agreeable baby, health, happiness, strength, the right medical staff, and good timing? Or was it really because she did a prenatal class that was somehow better than any of the other prenatal classes out there? Or was she determined? Or was she a positive thinker? Or did she have some good karma coming her way?

Probably a little bit of all of the above. When I am working with a woman I feel confident about, she has a good combination of strength, flexibility, confidence, vulnerability, self-knowledge, and a touch of who-gives-a-shit. She may or may not have an amazing support system and wide hips. She may have had a terrible childhood, and she may not be a very nice person. She may be having trouble in her relationship. She may have a lousy relationship with her mother. She may be tiny. She may be fat. She might not eat too well.

But there is a certain woman power that she will have, that will come out when she is birthing, that reassures me that this woman will not be too much of a challenge during and after labor. I am confident that labor will unfold, it will be powerful and most probably painful. It may make her feel like she is going to die, but I will be able to keep her to her path.

Most doulas, midwives, and physicians can tell you that they have a sense of a woman who is heading for a natural birth, if she is given the chance. The problem with most hospital births these days is that very few women are even given that chance. The epidural rate for first time mothers in the hospitals in Montreal is over 90%. That is no chance at all, for a woman who is feeling labor for the first time.

So, as the Muslims say, pray to Allah, but tie your camel to a tree. That is, don't rely on faith to make things happen for birth. Although much of it is chance, or fate, karma, or the divine, what is left over is human intervention - or human strength - or woman power. Let it shine!

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.