Sailing

There is a Muslim saying, "Pray to Allah, but tie your camel to a tree". There's a longer Jewish story about a fisherman who is having trouble in a storm and his boat is being blown towards a rocky shore. His advice is "Pray to God, but row away from the shore".

My oldest son is sailing across the Atlantic this summer. My friends and relatives have asked me if I am afraid for him. My answer is, well, actually, no. I know he is afloat in a 40 foot boat, bobbing on top of many thousands of feet of water. Rogue waves, storms, whales, and possibly even sea monsters do exist and are a threat. But his safety and well-being are not in my hands. I know he and his crew mates are conscientious and skilled. Beyond that, well, pray. Or at least have faith. Or just have a pragmatic or fatalistic view of the world. But the worst thing to do is either to live in fear, or to attempt to wrap yourself and your family in bubble wrap so as to avoid the rocky shore. At the same time, of course I am afraid. I would like my sons to stay at home and ... sit in the living room?

Of course, our fear and worry for our children starts when they are still in the womb. We try to eat well, to avoid dangerous substances. We wonder if they will be okay, even if we have an argument or become sad. Then during the labor and birth we try to have as gentle and positive an experience as possible, in the hopes that this will reflect on the small human's life.

Fear during birth has been discussed through history and is still a controversial subject. Unfortunately, it can be a pivot upon which a woman may make choices that can be dangerous for her and her baby. Of course, most of us, if we are told the baby may die if we do not do such-and-such, will agree to whatever it is immediately, in order to save the baby's life. Unfortunately, I have seen this type of prediction based upon bad science, or fatigue, or simply impatience, and I have seen women make choices based upon fear that they later regret.

The presence of a doula dilutes this feeling of anxiety and fear. We can radiate a sense of calm, that even when the most unexpected and difficult events take place, will allow everyone to do their work in a sensible and honorable fashion. We do not suggest that fearful predictions are wrong, but when a doula-assisted birth is going smoothly, and the woman and her partner are confident that the process is normal, then fear-based predictions are out of place. The medical staff will enter the room and recognize a normal, active process. The room is full of calm, concentration, activity, emotion, but the dominant feeling will not be one of fear.

So, my advice: keep your faith, but hire a doula!

Owning Our Practice

When we are working with such an elemental and mysterious thing as birth, it is often hard to tell where the lines that define ourselves and others can or should be drawn. I was speaking with another very experienced doula the other day who took exception to something I said. I suggested that inexperienced doulas may not be as successful at preventing unnecessary cesareans as a doula who has had years of experience working in a hospital environment with many diverse clients.
She countered, and rightly so, that the essential role of the doula is to offer companionship and respect, and those qualities will triumph, whatever the outcome.

I agree. To a point. Love works wonders. But a combination of things are at play, especially in a busy hospital that may or may not have a sensible approach to natural birth. A younger, less experienced doula may not know quite how to respond when a resident reaches for the amniotomy hook as she is doing a vaginal exam and prepares to do an amniotomy, all without saying anything to the laboring woman. Although we don't like to admit it, it is true that even the presence of a more experienced doula will help doctors to exercise caution. A less experienced doula will not know the policies and protocols of the various hospitals as well as a more experienced one. She will not have built relationships with the medical staff she is working alongside. All these elements can and sometimes do lead to the inexperienced doula accompanying a woman along a very different path than the one they had hoped.

That said, is that not our ultimate mandate? To accompany? To be a companion as the woman makes her journey? If we are beside a woman and her partner as they are becoming parents, and we are there to support, to love and respect, as the woman moves through labor, is that not sufficient?

Yes, if the environment she is birthing in is a sane and healthy one. Definitely. But what if a woman is birthing in an environment where the professionals are overworked, the infrastructure is crumbling, the focus is on risk instead of health, statistics are distributed as freely as narcotics, and the emotional and spiritual side of bringing a child into this world are more or less ignored? Then, possibly, a birthing woman needs more than a companion in love. She needs a watcher, a guardian. Experience, skill, humility, and an open heart are the foundation blocks that a doula can build her practice upon. And one important rule is: never stop learning. When you have a chance to change your mind, change it. When you feel you know enough, know you are wrong. The responsibility is great, the stakes are high. Ego should not take part in the miracle of birth.

Viagra?

I was listening to our national radio the other day in the car. There was a rather lame comedy show that took the place of a mock debate, with canned laughter and all. The debate was supposed to be about the perils of Big Pharma.
With a half an ear on the radio, one eighth of my attention on the road, and the rest of my thoughts on the woman I had just visited, I waited for a laugh - there must be some gags you can get out of the idea of drugs and the common man.
Into my consciousness blurted the voice of a youngish man, explaining the increase in Viagra's popularity over the past few years. In a ham-handed way, he was attempting to turn the problem around, and according to him, the reason why a 65 year old man couldn't get it up was because - oh, when he looks at his wrinkled, saggy, old 65 year old wife, what's there to turn him on?
I quote almost verbatim.
I was shocked. This is national radio! How can he be allowed to present older women, and older men, in such a light? Whoever talks about a long marriage with such disrespect? And how's it anyone's business anyway?
Then I remembered, of course, this is the 21st century. My 9 year old watches hockey games, where men are getting their necks broken by other men (I thought the game was about shooting a puck at a net?), and during the commercial breaks, he learns about Viagra, and imagines it is a pill you take when you are tired of going on walks.
In our drug-happy, Pharma-controlled society, little wonder that women do not expect to give birth without pharmacological pain relief. Men and women cannot maintain a long marriage without Viagra. Children cannot be controlled without Ritalin. For every mild ailment there is a pill. You can take a pill if you are shy, if you are sad, if you are scared.
But why not go through the real emotion? If you look at your old lover's body and see all the scars and lumps that were not there when you met, wouldn't that fill you with love? And if the love isn't Viagra love, so be it.

Birth Conspiracy?

I remember seeing a medical student who was attending his first birth. It was a normal, natural hospital birth. The woman was on the bed, her husband was by her side, I was next to him, there was an intern helping with the delivery, a nurse, the physician in charge, and a young medical student. The baby came out, everyone was happy, the new parents were exhilarated and crying, and then the medical student exclaimed loudly: “Look! Look! Look at its little toes! Look! They’re like real toes. They’re just like real toes!”
The attending physician looked at him and whispered: “Philip, get a grip!”, but I was hoping that that simple amazement and wonder would stay with him throughout his career.
For some people, this story may be full of problems and issues. What do I mean by a “normal, natural hospital birth”? Can a woman have a natural birth in a hospital? I remember hearing from an obstetrician that among some women in our city a “natural” birth was when you didn’t wear much makeup when you gave birth. What is a normal birth? If a hospital has a 90% epidural rate, does that mean getting an epidural is normal?
And certainly, we can’t have trained professionals going gaga over newborn’s toes, can we?

We are living in an age when we are terribly concerned with our health, yet it is an age when human life expectancy is at its highest. We worry and fret endlessly about our children, but have difficulty finding time to spend with them. We are living a life that is far from nature, yet we yearn for the “natural” and the “green”. We are so divorced from our own bodies that a surprising number of pregnant women do not know where their cervix is or how a baby is supposed to come out.
In our world, human life has become so complicated that every simple activity has a huge structure built up around it. This structure is built upon a foundation of information supplied by an army of experts. Simple processes such as eating, healing, making love, giving birth, breastfeeding, caring for children, have all become complicated and institutionalized. When a woman decides she wants to have a child, one of the first things she will encounter is the structure we have built up around birth. She will be met with a mountain of information and much of it will be conflicting.
In the birth world everyone wants to have a little piece of the birth experience. The birth practitioner wants a piece of even the most physical and elemental. Here is an example: It is often very tempting to do a vaginal exam. Why? We want to know what’s going on; if the baby is moving down, if the cervix is opening, where the baby’s head is positioned. What most practitioners will not admit is that this intimate physical connection with a woman is important to them: it is an amazing thing, to feel a baby’s head coming down the birth canal! But how often is it really necessary? Does the laboring woman actually want to have so many exams? How many vaginal exams are done for the sake of the birthing woman, and how many are done for the attendant?
The birth practitioner, or any birth “expert”, also wants a little piece of the bigger picture: we want the woman to have a natural birth, with no epidural and no interventions. Or perhaps we want her to have an epidural so that she can be more comfortable. Or we are convinced that surgery will be less risky. Either way, we want to convince her that we know best. In fact, we do know best: we are more educated, we have seen more births, we have seen more pregnant women and we know what to do.
Or do we?
The Birth Conspiracy is this: It is an understanding, created by all of us, that we cannot function without experts. We cannot give birth without birth experts. We cannot labor without assistance, without classes and checklists. We cannot make our own decisions, or accept consequences for our own actions. It is a way we can avoid responsibility for our lives. Those of us who are experts want and need to control the process. It is very hard to sit on your hands and wait while a woman labors. It is much easier to interfere, to preach, to suggest, and to control.

Interested? You can order your copy of The Birth Conspiracy soon - watch this space!

Birth and Fear

As I listen with exhilaration and with horror to the events that are happening in Egypt, I am reminded of what takes place so often in our hospitals when women give birth.
When I suggest that the masses in Tahrir Square may be a new force - a mass of people dedicated to peace and prosperity, some people look at me with pity, like
I am a naive fool. Who would think that people are generally good and peaceful creatures? Who would think that a woman could give birth to a huge baby without help?
Whoever is interfering in this generally peaceful process is working from a place of fear. Fear is always real, but it does not need to have the power we give to it. Birth can be frightening as well, but we do not have to act out of fear.
A few years ago, I was called to the hospital to accompany a lady who had already birthed a few babies naturally, so I wondered why she needed me there. It turned out that her family doc had bumped her up to OB care because of the suspected size of the baby - huge!
The woman was a tall, statuesque lady but not heavy. Her husband was also well over six feet. She was young and in good health.I will call her Helen. She labored for a while on her own and then called me to the hospital. When I arrived she was in good labor and progressing well. The OB on call was in and out of the room, feeling Helen's abdomen and shaking her head. They did an ultrasound which did show a large and active baby.
After about an hour, the Obstetrics resident came into the room and sat on the bed to chat. He suggested to Helen that the best route of delivery would be a Cesarian section. Helen laughed at his suggestion but became serious when he implied that the baby could die if she tried to give birth vaginally.
I decided to join in the conversation and I asked the resident, "What is the biggest baby you have ever seen delivered vaginally?"
"Around 8 1/2 pounds" was the answer.
He continued to say that if we just "let things go", we don't know what could happen - it was very frightening - we just don't know. I suggested that he never saw a vaginal birth of a bigger baby because he always intervened. And after all, eight pounders are the norm these days. Here was a resident who was embarking on a career of Surgical obstetrics! He was clear with us that it was the feeling of not knowing that was frightening for him. To his credit, he agreed to let things go for a while and see how the scary future unfolded.

Soon Helen was ready to push and she pushed her twelve pound, seven ounce baby into the world without a scratch.

We need to be aware and alert to possible dangers but we cannot let our own fears create monsters that do not exist. Let us be midwives of change - sit on our hands, watch, encourage, and assist only when needed.