COVID19 in-house Day 22: Birth and Choice

My dear friend Syd reminded me of something the other day when she suggested we all stop talking about "lockdown". Lockdown is something that happens is prisons. It's a scary situation when all of your freedoms are taken away. What we in Canada are living through now, most of us anyway, isn't that. It's scary and several of our taken-for-granted freedoms have been curtailed, but we are not in "lockdown".

I would like to take a minute to think about all the people who have had their lives deeply shaken by this pandemic: some people have lost their lives, others have lost loved ones. Some people's futures are changed beyond recognition, other people's present lives are changing as quickly as thought. In some countries, the biggest risk is starvation because there's no way to get out to get food and no way to make a living. In others, people are struggling to get by on what little they have.

But all of us in this world, together, are living through this historical event, whether we like it or not. We all have to figure out creative ways to live, to rise up to the new challenges we are faced with. Here in Montreal, most of the people I know are staying home, except for the health workers amongst them. Those brave souls are out in the hospitals and clinics, keeping us healthy, providing for the sick, and juggling their own lives and families with the needs of others.

I worked as a birth attendant for twenty years, and I trained doulas for fifteen of those years. One of the qualities I always valued in a student doula was flexibility. If a doula has that quality of making virtue of necessity; if she can take a challenging situation and make the best of it, then I am confident that she will provide the very best care for her clients. It's tough, sometimes, when a client wants her birth to go a certain way, and you as her doula know that it's unlikely that it's going to go that way. It's tough when your client is going to birth in a hospital where you know that the protocols don't "fit" with her beliefs about birth, or when things take a turn and interventions are needed. In these situations, I teach my doula students a few main lessons.

The first one is: when you and your client enter into the hospital, you are entering someone else's home. In the hospital, you don't make the rules. When you're in someone else's "home", you follow their rules. When your client is in labor is not the time to try to change the rules. A birthing woman should not have to spend her labor time battling with her attendants. She should have a realistic idea of what will happen. If she doesn't agree with the rules, then she should make other arrangements.

The second rule is: as the doula, you are there to support your client throughout the journey. In every scenario, with whatever tools you have at your disposal. Again, now is not the time to argue with the medical staff. Now is the time to concentrate on accompanying your client as best as you possibly can, so that their experience will be positive.

The third rule is: love your clients, love the staff, love the birth experience, love the baby. The more love you can spread around, the better.

Two major maternity wards (also here) in Montreal announced this week that because of Covid19, patients giving birth would not be allowed to bring anyone into the birth room. Not a doula, not a partner, not a mother. This has sparked a huge controversy and many people are angry, many are worried about how their birth will unfold, and petitions and news articles are all over the social media.

I do understand how scary it is to give birth alone. I've done it, in a foreign country, and it's not pleasant. (Actually, that's an understatement. It's traumatic and awful. But I didn't have a doula, and I didn't speak the language.) I believe that the maternity care system here in Quebec is broken: it's been broken for a long time - there aren't enough midwives; the laws around midwifery care were badly conceived; the maternity wards are understaffed and overly restrictive. In twenty years, I've heard many, many awful stories about giving birth in Quebec.

But this is the worst time to start to fix it. The worst time to try to change it. The worst time to push against a policy that actually will save lives.

It's a difficult time to give birth. It's a difficult time to stay alive. It's even a difficult time to die, as funerals are restricted. But this is a time when we can use all the resources we have to make our experiences better. So, doulas, I am calling out to you to do your very best work, and prepare your clients with love and compassion so that they can look forward to their birth with joy, and they can enter the hospital knowing that, yes, they will be cared for. The nurses are in fact there to care. You will be FaceTiming them from your home, guiding your client with your voice, letting them know that you love them, that they're doing a great job... using all the skills and creative tools at your disposal in the trying times.

After this is over, let's fight together for decent maternity care! Let's make a note that, yes, maybe hospitals should be for sick people and birth belongs somewhere else. Let's fight for more midwives, for more birthing centres, for an understanding of pregnancy as a normal, healthy event. But let's save that fight for later. For now, let's try to live together, with love. Doulas, be creative! Use your voice to provide support for your clients, where they are.

In these complicated and challenging times, let's pool our resources to work together! Spread the love!

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!

Brutal Births for Asylum Seekers

Yes, as if it wasn't bad enough leaving Mosul, Aleppo, Damascus or any other not so well-known  place where war killed thousands and maimed more (have a peek here to get a sense of the immensity of the crisis), yes if that wasn't bad enough, if it wasn't bad enough to flee - to have to flee, leaving a normal life - the kind of life you and I lead - with phones and laptops and going out to eat and new clothes and a job and a house and cool stuff and a country you love or you love to complain about -if it wasn't bad enough to run through a country you didn't recognize, and maybe get caught by the police, or maybe your brother gets caught and he throws you his child - and you keep running - and then if it wasn't bad enough to have to live in a tent, when you're pregnant and having to pee all the time, and your sister is in Turkey and you are worried about her, and its your first baby and you don't know anything about having a baby because you were studying finance in University before all this shit started - and if it wasn't bad enough to get a call at midnight from the UNHCR telling you to pack your stuff because you're being relocated tomorrow, so any friends you had you can only communicate by Whats App because no one can get around much - and if it wasn't bad enough that you packed all your stuff in one nylon bag, and your belly is hurting and you don't know why, and you are moved to a hotel past the airport, and there is an abusive helper man there but you can't tell anyone, and if it wasn't bad enough to be living in a hotel, with no chance to cook so you want to be back living in a tent in a warehouse ....

Then you may be in labor but you don't really know - and who has ever been pregnant for the first time knows how this feels - and of course we get calls all the time when people think they're in labor and they just need some love and reassurance and they usually go back to sleep, unless they really are in labor in which case we go to be with them.

But in any case, there's no one to call, and you're frightened for the baby, so you call an ambulance. And indeed you're not in labor, but its kind of around your due date, and your baby's big according to the ultrasound, so you have a c-section. Alone, because husbands aren't allowed in, and because you don't have a doula, and because just because. Your life just gets more and more painful, and the blood is awful, and the people speaking Greek to you, loudly so you understand, but you don’t understand anything – not why you had to leave, why you are running, why you can’t just go to Switzerland where your brother is, why you are having your baby cut out of you instead of how normal people have their babies … it is awful, and you think about your friend a few years ago, she had a baby. She had it in the hospital, back home in Syria, she said it was painful but nothing you couldn’t do with just a little encouragement. Her older sister went with her, and she had a nice doctor.

Cesarean section rates are ridiculously high in Greece, much higher than the recommended 15% that the WHO suggests is a rate that both protects mothers and babies, and higher than the rate was in Syria before the war (see Syrian c-section rates here). Our average in Canada is around 25%. That’s one in four babies born – but those figures vary widely across the country and across socio-economic lines. More wealthy and educated people in Canada are now working hard to have a vaginal birth, and of course the possibility of midwifery care greatly increases your chance of having your baby vaginally. My private doula clients have generally had rates of c-section varying from 6 to 15 %. The volunteer doula program I led for many years served marginalized families in Montreal, and our c-section rates were high – up to 35%. I am extrapolating from my figures and from what I heard from the mothers I met, and I suggest that from a Greek 60% it may go up to closer to 90% for asylum seekers, in a rural hospital next to a refugee camp.

If you are an asylum seeker in Greece, you are at the mercy of spotty health care, and that care is embedded in a system that doesn’t work! The medical NGOs are doing their best - Medecins du Monde, Medecins Sans Frontiers, SAM, Rowing Together ... but prenatal care is patchy. And there isn't the kind of continuity that always makes a difference. Frequent ultrasounds are the norm, instead of quality week-by-week prenatal care. Logistically, it’s easier to plan an induction or a c-section than to have a laboring woman transferred by … by what? Taxi? Ambulance? Someone’s private car?  … at 3 in the morning if she goes into labor and has been relocated to the back of beyond? So she gets the call from her doctor, or a doctor who comes to the hotel or the camp, and off she goes.

The word is, that doulas aren’t allowed in the hospitals, but I don’t believe it. I believe a friendly, smiling face accompanying a laboring mother will be welcomed by the hospital, especially if that mother starts screaming the doula’s name when she is separated (sorry, yes, I have done this). I want to change things around for these mothers, and provide them with caring companions who will be with them through thick and thin. Even if they don’t get to go into the labor room, even if a mother does end up having a surgical birth, a smiling face at the end of that tunnel is a life-changer.

I’m not big on bureaucracy, protocols, rules. I believe kindness, unconditional love, and a little who-gives-a-shit attitude can go a long way. I am determined to change some peoples’ lives for the better, starting with their birth day.

Who’s with me? Please let me know if you would like to be part of my dream: leave me a comment and I will reply as soon as I can, or join my group on Facebook: Birth Companions International.

Witches

Hard on the heels of news of a very disturbing trend in Spain came one of the most amazing births I have ever been honored to attend. So, I think two posts will have to be written, and I am working hard on absorbing and learning everything I have been experiencing in the past week.

First, the disturbing news. Many of us in the birth world, especially in Europe, have read about the Spanish association of nurses' official report on doulas. This report apparently took a couple of years to compile. It is an attack on the doula in general, and contains some specific accusations against certain doulas in Spain who may be identifiable (only to themselves and close friends).

The document contains some bizarre accusations: that doulas divide families, that they practice cannibalism, that they condone obstetric violence. Because of the bizarre nature of some of the accusations, several critics have suggested we just ignore it as a childish outburst and get on with promoting natural childbirth, and the doulas and midwives who facilitate it.

I don't agree. I believe this report has all the trappings of a witch hunt: the exaggerations, the caricatures, the false accusations, the violence, and the "scientific" pretensions. These campaigns are usually driven by fear and ignorance but at this point I am not really interested in figuring out why, I just want people to recognize that this is important, and must be publicly spoken out against, as soon as possible.

I know that Spain is a country with a long history of persecution and accusation. The Spanish General Nursing Council should be more sensitive to the precedents set by Spain's leaders throughout history, who have shown little ability to look at the facts and make informed decisions. From the Spanish monarchy in the 15th century, who have the dubious reputation of persecuting the Muslims in their midst, burning and deporting the Jews in 1492, then sailing off to new climes to kill and destroy ancient civilizations, through to modern times, when the country rose in flames to kill each other, and lived through a brutal dictatorship right up until the nineteen seventies... Spain has not been a peaceful land. 

We believe, as Birth Keepers, that gentle birth is the way forward for peace on earth. I believe that a renewed campaign against gentle birth keepers is a campaign against peace. It's a campaign against those who are trying to change our abusive, violent birth machine into a place where people of all kinds can birth their babies and their futures.

You may say I am sensationalizing. I know that there were Jews in Berlin who were also accused of sensationalizing when they tried to tell their people to leave. You may say I'm drawing the wrong parallels. I know there is a child in a Spanish orphanage right now whose mother had a home birth with an independent midwife. 

Just last year, an Italian midwife was docked six months of work for teaching a doula training class: 

The accusation against her is that of having violated the Professional Code of Conduct of Midwives by her participation as instructor during instruction courses for birth support personnel known as doulas (defined on that occasion as “persons capable of damaging the health of women and infants”).We would like to take this occasion to communicate that the Professional Code of Conduct of Midwives includes the provision that it is within their scope to provide training for support personnel (art 2.4). The sentence, besides being extremely serious in itself and for the midwife concerned, also casts a shadow over the figure of the doula (cited and recognized as a support person for women in the Care in normal Birth, by WHO – ed. 1996; par 2.5 – and cited in the recent Guidelines to caesarean sections by the Italian Ministry of Health, ed. 2012, pg. 80-82), creating a precedent which we would like to bring to the urgent attention of doctors, midwives, doulas and parents. We wish that this case is brought to the attention of all birth personnel in Europe and the rest of the world." private message, May 26, 2014.

The fact that these accusations are surfacing again, in a different country, is very serious. Europe is a volatile place and the witch hunt against doulas and independent midwives could spread. The campaign could move from bizarre 25 page reports to different types of accusations and investigations. I am not saying this to make people afraid; rather, I am suggesting we should not act out of fear and try to hush things up, worrying that we will be spreading the word that doulas are to be avoided. I am suggesting that we take full action, as full as possible, so that this witch hunt doesn't spread any further. 

What to do?

• Read about it: https://wysewomentalk.wordpress.com/2015/02/17/are-spanish-doulas-really-the-walking-dead/
• Sign the petition: Withdraw the doulas report

• Make a circle: Doulas and Birth Keepers of all kinds need to pull together and stop squabbling. In each country, we need to see a strong organization that represents ALL doulas, no matter where they trained or how they are certified (for example, see Association Québécoise des Accompagnantes à la Naissance).

• Attend births! Educate birthing mothers! Educate the public! Provide doula support to families during the childbearing year! Flood the social media with images and stories of gentle birth!

In the spirit of real birth, gentle Birth Keepers, and moving forward to a peaceful world, let's reach out to each other and be the change we all need.

Losing Your Self

Back in the fall, I went to a birth. It was the first birth I'd been to in a long time. It was wonderful! But it was very different from how I imagined it would be.

I always love the feeling that I am doing exactly what I was meant to do: accompany women during childbirth. The most important lesson about birth is that it is very much like life: you can't really plan for it. Meconium happens. Stuff gets broken. People get lost. Suddenly you turn a corner and there is the most beautiful sunset you've ever seen.

Here is a picture of an obstetrician waiting for an unsuspecting pregnant woman. She is being pulled along to the birthing room by her husband...dropping her slipper like Cinderella...he is rushing to punch the clock ... I'm late! I'm late!

The doctor holds a limp pair of forceps in his hand. He is going to get this baby out, for once and for all!!!

Of course, birth doesn't usually happen according to our plans, or according to anyone's schedule or hourly rate. Babies come when they want, or when they need to leave their mother's womb, or when the womb needs to expel them. Who knows. But they don't generally show up when we plan for them to.

And then when they do, the birth unfolds in a different way from what people had been expecting or planning. Which is why I still don't believe that birth plans are useful. Not because birth shouldn't be thought about and considered deeply, that choices shouldn't be made about where you want to give birth and with which people around you. But because the unfolding of your birth experience, of any birth experience, is unpredictable and can't - shouldn't - be pinned down. Because if you try to capture it with a plan, you could miss out on something extraordinary that you hadn't thought about, that couldn't be contained by your plan.

So, what does that mean for us attendants? How do we plan our days and our lives? 

Birth attendants are often on call day and night. Doulas may be on call for months at a time, unless they structure their work effectively by creating a doula collective which involves sharing care. But most doula clients want the continuity of care that means that one doula is always available. So there go your plans for family events, sleep, trips....

But in a deeper sense, when you are actually attending a birth, when the labouring woman is there deeply in the process of birth, then what? Are you thinking about what groceries you are going to buy tomorrow? No, you are with the labouring woman. You are providing support for her and her family, her partner, whomever. Even if you are sitting in a comfy chair knitting: your intention, your senses, your compassion, your heart and all of your focus are bound up with the birth process and the safe place you are creating for the newborn family to move through.

And then you lose yourself. You forget about your worries, strengths, failures, envies, moods. Your only task is to serve birth. You are serving the woman as she moves through her experience of birth, as she becomes a mother. And are you the most important person in the room? Is the obstetrician the buck upon which stuff stops? Of course not. The most important people in the birth room are: the mother and the baby. And how they are treated by everyone else is the most important aspect of the whole process. So, the less we all worry about ourselves, and the more we focus, truly focus, upon the family-to-be, the better off everyone will be in the end. Losing yourself is just the beginning!

Serendipity

“Our work in this area began when one of our medical students failed to follow the instructions for another study. She was only supposed to obtain the approval of primiparous, healthy mothers in early labor. They were then to go through the usual hospital routine, and the study was to begin at their babies' birth. She obtained the approval for the study early in labor, but stayed with each of 10 study mothers giving emotional and physical support until they delivered (family support was not permitted in this hospital). When we first heard about this error, we were upset, because all of these mothers and babies had to be removed from the ongoing study. However, when we looked more closely at the charts of these mothers, we found that they had unusually short labors. Surprisingly, three of these mothers delivered in the bed. This was unheard of in this hospital, because the focus of the delivery unit was sterility, and the rules of the hospital were that every mother was to deliver in a "sterile" delivery room. It is this serendipitous observation of altered labor with emotional support that has been the focus of our research for the last 10 years.”

Klaus, Marshall H. Touching during and after childbirth. In Field, TM (Ed), Touch in early development (pp19-33). Mahwah, NJ, Lawrence Erlbaum. 

E-book

E-book!!!

We finally jumped into the electronic age and decided to make an e-book of The Birth Conspiracy available....for all you birth keepers out there who want a light, easy-to-carry version, or for those of you who travel... or for any of you who prefer electronic copies...(I like paper books myself...)

Here it is! You can buy it now for $12 Cdn. Just click on the button below and it will take you straight to the Paypal page where you pay, then you will be directed to the download.

Buy Now

Freedom For Birth (Web version)

Birth - The Need for Community

One thing I really enjoyed about the workshop I just led in Halifax was the feeling of community among the women there. Although the participants were mostly doulas, we also had participants from other professions who were just as happy to be there, and who enlivened the activities with their own insights. We ranged in age from just a few weeks old to quite elderly. Some of us work as private doulas, some volunteer, some have a "day job", and doula on the side. It was very refreshing to see such a mixed group of people really connecting and working for a common good - of course, that particular common good being the most women having the best birth experiences.

I had an interesting conversation with a midwife in the group who was discussing program options with an aspiring midwife who now works as a doula. The talk led to the issue of bullying and unkindness within the birth community, and unfortunately it is a real problem that does not go away if it is ignored.

Because birth is so important to us all, and because most of us who work with birth are usually very busy, there seems to be a natural progression to some bad habits. It is so important for all of us to take a good look at ourselves and our beliefs and actions every once in a while. We can see that, for example, we are holding on to a belief about birth that does not apply to every woman. Or that we are being less charitable to those less experienced, by simply criticizing instead of taking time to teach. Or perhaps we feel very strongly about a certain aspect of birth, and hold on to it too dearly.

Attending birth is all about letting go of your own ego and your agenda, and accompanying a woman as she makes her own journey to motherhood. It is also about reaching out to others who are on this path, and being able to accommodate the reality that there are many of us on the path, that we all have different opinions and histories, and that the most important thing is that we walk along together with an attitude of respect.

Not to say that we can't ever disagree. Of course we can. Nothing better than a good argument. But that argument should never, ever take place in a birthing room. It should never descend to personal insults. And if there is no accommodation in sight, no agreement to be reached, then at least we can agree to disagree and continue to work together to provide the very best care for women and their families.

Natural Birth Workshop in Halifax, NS

Contact the Nova Scotia Doula Association for details.

Girl Code?

Please visit the sisters and like my post! This will earn me one vote towards earning my Jetsetter edition course.

I just love it when I see women doing innovative and upbeat stuff. I love Savon Populaire - run by a trio of women, who have a few kids between them  and still manage to run a successful business (that also smells like heaven!)

Or there's Motherwit, also a Montreal-based business, run by our city's busiest and well-known doula, who leads a team of women who have accompanied many families through pregnancy and beyond.

My  Sicilian friend Ninni mixes her love for design with her desire for social justice to produce amazing creations, and she shares her knowledge with prison inmates to assist them to imagine a life outside of their limitations.

When I think of it, there are hundreds of amazing women I know and have known through the years, who have an idea, dream about it for a while, and then just get up and do it!

So - the code part - I just discovered another gem of a business, run by two enterprising sisters, who have decided to open the doors of web design to the common woman! Their site, The Girl's Guide to Web Design, looks very cool, works like a dream, and is full of interesting tidbits.


I had a lot of fun working with my sister on The Birth Conspiracy, my recently released book on natural birth, doulas, and hospitals. I loved working with her, and I was so happy that she agreed to put her amazing talents into our project.

The book is selling well, and we are planning three launches in different cities over the next few months. We are organizing a workshop in Italy in the summer with a great bunch of people, including our friend Lewis Mehl-Madrona, doctor, healer, storyteller, and author of Narrative Medicine.

I have so much going on - my volunteer doula organization, my own private practice, my workshops here and abroad, writing projects ... and I want to be able to use my voice more effectively and with a bit of a splash - I love techy stuff and I am always looking to learn more.
I envision a site where women can browse and gather information about natural birth, or find a doula, or sign up for an international workshop; get resources on anything from birthing in Sicily to doula projects in the Caribbean; find out how to join a writer's workshop ...and I want it to look good, and to work the way it should: big, beautiful, friendly, and cosmopolitan.

Which program? Jetsetter, definitely. I have been doing self-directed study since I was in high school; I love the name; and I can go at my own speed wherever I am.

Fun secret fact? I love to play the clarinet - from Brahm's Clarinet Sonata in F Minor, to some low-down blues after a few shots....

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.

Friends

I was so grateful to a dear friend the other day who offered me an opportunity to try to put things right between us. I had been at fault and I made the opening moves, but she was gracious enough to accept them, conditionally.

When you are working in such an intense field as birth, it is so important to have friends around who understand what you are talking about when you need to discuss how you feel about a birth, or a woman you are working with.

One of the doulas I work with summed it up the other day: she had been present for a family who had a difficult and potentially traumatizing experience. Everything was fine in the end, but during the stress of difficult events, one of the family members took her anxiety out on the doula, who chose to receive it in silence and then process it elsewhere.

She did that successfully, but during the few days we spent talking about it, she told me how strange it was - she had gone out with friends, been with her family, lead her life normally amongst people, but she did not feel that she could discuss what was really bothering her until she spoke to another doula.


Community is so important. Please, reach out to someone you have experienced a break or a rift, or perhaps you have unjustly dealt with in the past. I promise you, we will all be better off for it, and the community itself as a living, breathing entity, will be healthier.

Volunteer Birth Companions

I am very happy my book is selling - by the way, people, it would be a very nice Christmas or Hanukah gift for any of your close friends or relatives who are expecting a baby in 2012.

Please visit Amazon to review or "like" my book.

I want to tell you about the Montreal Birth Companions. This is a group of very special women who accompany underprivileged women  during their labor and birth experiences. Most of our doulas are just starting out, but some of them have been working with us for years. They are all volunteers, working out of their own pockets and from the goodness of their hearts to help other women have a joyous birth experience.

One of "my"doulas has been volunteering for months, doing her own research, studying,doing courses with different organizations and waiting for her time to accompany a woman in labor. Finally, yesterday, I got a call from a nurse to tell me that one of their patients who is alone here in Montreal was in labor and wanted a companion.

Our doula rushed to the hospital, where she witnessed a beautiful natural birth and was able to provide comfort and companionship to a birthing woman. She is hoping to be accepted to midwifery school this year, and I hope she gets in. She is a natural!

Book Launch Tomorrow

It's finally here. My book is written, illustrated, edited, proofed, and printed. It is ready to go, and tomorrow night we will be celebrating.
I hope all of you in Montreal will be able to come and celebrate with us. The launch will take place at 6767 Cote des Neiges, from 7 to 10 pm, and of course children and babies are welcome.

In the meantime, life goes on. I am waiting on a lady who is going to call me any minute now to accompany her during her labor and birth. I have another lady due in a week or so, and I am hoping that baby doesn't decide to arrive tomorrow night.

My mind and dreams are now full of my next book, so watch this space....

And I went to visit my father last week and did the doula in the geriatric ward where he was staying. The doula approach, how we utilize our skills, how we "do the doula", is the same whether we are attending a woman in labor, an old man in hospital, or a teenager having a meltdown. We wait, watch, listen, sympathize, fetch ice, carry water, sit still, put hands on, keep hands off, speak when spoken to, make eye contact.

A hearty thank you and much gratitude to all of those who have allowed me to be present at their births, and to all of the doulas out there who continue to do this challenging work.

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.

Feel the Love

Blackberries are my favorite fruit. I made four jars of blackberry jam this morning. I made a blackberry pie the other night. They are in season around my birthday, so they are a yearly treat for me. They taste of the end of summer, the sugary heat of June and July is stored in their black bubbly taste. They have a rich taste that lends itself well to jam. So I'm jamming.

Jamming and reading my emails. And I read a beautiful account of a birth attended by one of "our" volunteers doulas. She assisted a mother who labored for many hours, and finally the decision was made to go to surgery. The baby was born, and the mother is recovering well from surgery and is mothering, as we do, to the best of her ability. Her doula was fully present for mother and baby from the beginning of labor, in the labor room, in the operating room, and at home.

If I look at the details of the story, I could probably find places where decisions were made that were not optimum, that may have led to further interventions, where this woman could have avoided surgery. But that's what I love about "my" volunteers and apprentice doulas. They are not working from information, experience, or an agenda. They are the best doulas I know, because they are working from a sense of companionship. They are loving the birthing woman.

I know several artists and musicians. A familiar refrain in the world of creativity is "Ah, if I could draw/see/play as a child does! If I could regain that way of looking at the world, where everything is new and interesting." In the birth world, as well, that sense of innocence, of wonder at birth, is something that we all strive to keep. I remember when I was looking forward to going to my first birth - I would have done anything just to be at that woman's side and accompany her through labor and birth. Not to say that I am not as dedicated to birthing women as I used to be. But I know them better - I've seen more - I don't have that freshness of vision that a "new" doula or a child has.

As doulas, we need to remember to forget ourselves and our knowledge when we are accompanying a woman in labor. Just as I greet the first wild blackberries with joy and appreciation, we should greet every birthing woman with respect and with a sense of her "newness" in the world.Forget about how much or what you know, and remember that it is her journey and you are a guest. Be happy.

Doula Breakdown

Last week was a week full of difficulties and ruptures - it wasn't a rapture, silly, to quote my dear friend Syd...

All sorts of very difficult things happened to a lot of people I know, and by the end of the week I was just wondering what was going to happen next. And then, after a rather difficult labor and birth, a proud new grandmother hugged me and said, "This is the happiest day of my life"!

It was the same day a very gentle and wonderful woman in our family passed away, so it was especially poignant to me to see the paradox of being alive with such clarity.

A couple of months ago I called one of my apprentices to let her know that our client was in early labor. She said she just couldn't come with me - literally that minute she had broken up with her boyfriend. I let her know that this is something that happens - the doula's life goes on, and even if something disturbing is taking place in your life, you can still put that something in a box and go to take part in another woman's joy without reserve, clean, fresh, and open.

How do we do this? I have spent many taxi rides doing just that - letting go of my worries about one of my sons, or the fact that my husband and I had planned a much-needed evening together, or what that strange phone call was about from my dear friend. I let it go, and I try to concentrate on the woman I will be attending, and her needs.

Sometimes the doula does have to take a break from doula work in order to concentrate on sorting out her personal issues. I remember several years ago when a doula called me in tears because her husband was not happy with her being away at nights. She chose to move to a different area of maternity care and is happy doing childbirth education and staying home nights. I personally take a break every summer and turn my energies to creating a different sort of life in a very different environment. That life may include birth one day, I don't know right now, but I do know that I am happy without my pager when I am working the cement mixer up on our mountain.

Just fixing everything up here with a little love, some words, and a dab of cement!

Doula Love and Accountability

I have raised a lot of eyebrows with yesterday's post so I would like to go back and comment and try to clarify. One message I was sent was this:
"Doulas don't cause Cesareans. Emphatically. Doctors, emergencies, and women's choices do."
Yes!! Absolutely! And we, as doulas, need to remember this. It is ALWAYS the woman's birth, and not the doula's. No matter where the path leads, it is the doula's mission to follow, and to respect and nurture the woman she is accompanying.

Another message went like this:
"When I'm at a difficult birth, even though I've only been practicing for a few months, I know that I am providing something that no one else can, and that is unconditional support. I know that I'm not responsible for the outcome of the birth, and I hope you realize that inexperienced doulas may take your words seriously."

Still another:
"Yes, we need to take responsibility for what we do - and if a woman in my care has an unnecesarian, I take responsibility, I try to work through it to improve my care."

Wow! Please comment on my blog. I appreciate your messages but I would like to make this discussion public.

To clarify, I would like to publicly apologize to any young/inexperienced doula who was hurt by my words. That is the last thing I wanted to do. I would like to engage in an ongoing discussion about responsibility and transparency. How do you feel when your client has an unexpected outcome? How do you feel when you have a feeling she will end up in surgery, even though she is planning a natural birth? Do you change your practice? Do you call in a more experienced or differently trained doula? What do you do when you are at a birth and things start going haywire? Do you reach out to other doulas?

Whenever I am at a birth that ends in an unexpected c-section, I always look back at my actions and the prenatal and labor process to see if I could have worked differently. Sometimes I know I did everything possible. Other times I know I could have done more. I know as doulas we are not held accountable, as medical professionals are. We form associations and collectives but we are accountable, in the end, only to ourselves. I know I am very hard on myself, always wanting to do better, and I would do good to accept that meconium happens.

To all of you, keep up the good work, and keep on loving.

La Dolce Vita Benefit Dinner

I met a lovely group of women the other night - and I am honored that their organization, Dining for Social Change, has decided that MBC will be the recipient of their upcoming Tuscan dinner.

The event will take place on March 12, 2011 at 7pm
at 5213, rue Hutchison, Montreal .

The dinner will be prepared by a local chef and promises to be a great event. You can eat, drink and be merry, and know that you are supporting a very worthy cause.

The  Montreal Birth Companions  mandate is to provide free doula services for women who are in REAL need: recent immigrants, refugees or asylum seekers, or women living on the street or in difficult circumstances. Our doulas do prenatal classes with these women and then attend their labor and birth. We run on almost no cash. Most of the work we do is a labor of love. We serve about 60 women a year, and one client takes up to 50 hours of a doula's time.

For tickets, please click here.

Looking forward to seeing you all there!