I’m trying to unravel my complicated responses to the article that came out in the Guardian last week about the Freebirth Society. Of course, the article has snowballed and it seems everyone I talk to now is indignant and shocked about the phenomenon of “freebirth” that the articles seek to condemn.

Let’s try to have a look at this Gordian knot of issues, and try to understand what exactly is happening.

Essentially, this phenomenon, specifically the Freebirth Society, is a product of a perfect storm that was created by a few very different variables. Obstetric violence is a reality. Although women are subjected to violence during birth all over the world, the affluence we enjoy in our part of the world gives us extra time to contemplate on what birth would look like if there wasn’t pervasive infantilization, abuse, or even just downright rudeness to contend with while we are producing a new human. Finally, add in the social media, where opinions and indignation can spread like wildfire, and you have fertile ground for a movement such as this.

One of the difficulties with this article and its offshoots, is that the authors confuse the Freebirth Society with the tiny but growing movement of women who are trying to find a way to give birth that doesn’t include routine unnecessary (and dangerous) interventions (see this article in the New York Times), that also doesn’t put themselves or their babies at risk. But let’s make no mistake: both the FBS and the community of women who are trying to find a more moderate path are reacting to a real problem in the real world.

What is the problem? Our c-section rates are too high (at least double the recommendations by the WHO). Our epidural rates are close to 100% for first time mothers. In the US, maternal/infant mortality rates are abysmal, especially for women of color (across economic lines) which indicates that perhaps modern obstetrics is not serving us well. And the fact is that thousands of women go to their doctor’s appointment and get ignored, or have their first baby and get manhandled, or have a c-section for a fatuous reason, and these women want something better.

Manhandled? I’ve heard doctors speak sexually to birthing women. I’ve seen hundreds of procedures done to birthing women with no consent asked or given. I’ve seen hundreds of vaginal exams done without consent and for absolutely no reason, it seems, except to shame the woman that her body isn’t working properly.

Fatuous reasons? “Your baby is too big” (then it’s a seven pounder). “You’ve been seven centimeters for two hours”. “Our software shows a high risk of shoulder dystocia.” “I’m leaving for vacation next Tuesday so come in on Friday to have your baby”.

Here’s the problem, though. Shit can and does happen. It isn’t always groovy to have your friends and some nice music. That’s why humans have always had midwives: women, usually older, who have witnessed many births and can tell when something is going sideways and can know what to do or when to get assistance. Unfortunately, the women who are turning from modern interventive obstetrics are also turning from midwives who, they claim, are just handmaidens to the obstetric machine. This is becoming more common, as the younger generation of midwives graduating from medical schools are trained with the same eye to risks and precautions that the young physicians are, and they graduate looking more like their physician colleagues than midwives from even a generation ago.

The percentage of women giving birth outside the hospital (this includes those who have a registered midwife in attendance) in Canada is less than 3%.1 We don’t know how many of this population are choosing to give birth outside the medical system with no registered medical professional in attendance, but let’s give it a generous number of 1%. Internationally, that number seems to hover between .5% and 2.5%, but these also include women who didn’t plan to give birth outside the system (for example, those who birth precipitously).

So why are we making such a fuss about such a tiny portion of women? I believe the same three variables I mentioned above are at work seeding and maintaining our outrage, with another important one added in to create a perfect storm in a teacup. Obstetric violence is real. It is true that obstetrics is one medical field where informed consent is often lacking; where unnecessary drugs and procedures are common; where the medical staff are usually not interacting with someone who is ill. In a way, it’s easier and more sexy to write an article about a small portion of women who are doing something really dramatic about a problem that everyone knows is endemic and isn’t going away very soon. Our affluence and ridiculous amount of leisure time make us more vulnerable to such sensationalist articles, and we need to be enraged about something, so why not get all het up about some independent-minded women?

And, of course, the social media make it easy for everyone: the FBS were champions at identifying who wanted to hear their stories, and making them accessible. And who wanted to hear their stories? Those women who were seeking a different way to give birth: one that didn’t include “being talked down to”, “too many vaginal exams, by several people at a time”, threats that the “baby will die”, overeager active management of the third stage resulting in dramatic PPH… the list goes on.

And the journalists, on the other hand, witnessed the train wreck that was the dissolution of the FBS social media empire, and rushed in to “investigate”. I am critical about how the article was written, and of some of the “facts” presented. First, I don’t believe that the absolute devastation of losing a child or having a child born with severe developmental delays should be described in detail in an article. Simple as that. In my opinion, that kind of sensationalism does no good and can only do harm. How? It doesn’t accurately tease out the physiologic facts from the drama. Yes, 17 minutes of shoulder dystocia is unthinkable (who was counting?). But do we really need thousands of people convinced that birth is an absolutely terrifying and dangerous event? Or do we want to focus on the matters at hand? Further, the statistic produced at the end of the first article may be true, but it isn’t backed up with evidence. And it uses the same dramatic anecdotal “facts” that the FBS does to convince people of the truth.

There’s one more piece to the puzzle, however. Look at the title of this article! “Influencers made millions pushing ‘wild’ births – now the Free Birth Society is linked to baby deaths around the world.”

We don’t actually know if giving birth without a medical professional in attendance is safer or more dangerous than giving birth with a doctor or midwife present. The data has not been gathered, and all we have at this point is polemics. We all have our opinions: I have mine, you have yours, and your neighbourhood OBGYN has theirs. But until we can actually look at the data and draw our conclusions, we are left with stories. For some, the most shocking part of the story is that the state of maternity care in our affluent society is pushing women to make possibly risky decisions. For others, it is that babies are being born either still or severely compromised, and our hearts are breaking. For some, the shocking part of it is that women are continuing to be maltreated in hospitals and birthing centres, and then demonized for making unpopular choices. And for some, and it seems the journalists are playing to this crowd, it’s that a woman who was passionate about her belief that women should give birth in a joyous manner, used her talents as an influencer and an organizer to “make millions”.

There are bigger problems in the world, to be sure. But we all get born, and I have worked in this field for almost all of my adult life. Here are my three suggestions:

First, that we pull our heads out of the sand and look at the real state of obstetrics here in Canada, and ask the question: is it really serving young families?

Secondly, that we gather actual data on out-of-system births so that we have facts instead of emotions upon which to base our opinions (and policies!).

And, third, that we recognize that the phenomenon of women choosing to birth outside the system is here to stay. How can we best serve these women? By alienating and demonizing them? Or by asking them what they want, what they need, and how (if at all) we can help?

1

https://www150.statcan.gc.ca/n1/daily-quotidien/220928/dq220928d-eng.htm

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.

Finding Center

I lost my centre over the past few months and I'm not sure how. I've been feeling like a small boat in the middle of a big sea. The desires and defeats and dreams of others became my reality. I stepped up to a plate I don't really like.

Yesterday,  no it's last week now, I ran a half marathon, that's 13 miles. My phone had broken so I didn't have music to listen to, so I only had my own thoughts and the sounds of my feet, my breath, and other runners talking or the Canada Geese honking in the background. I thought about how I have gotten to where I am, and how my beliefs and convictions have changed and matured over time, but how they got mixed up and sidelined over the past year or so.

Women's reproductive health has always been very important to me. I've worked in the field of maternity care for over twenty years, mostly as a doula but also as a midwife. I am not registered to practice as a midwife here in Canada, so I've restricted my practice to other places and different ways of practicing. 

As the complications and controversies grew and thrived as we lived through a pandemic, I started to hear from women who did not want to go to the hospital to have their babies, and neither did they want to have their births attended by registered midwives. In their opinion, the restrictions put in place for birthing women and their families were oppressive and inhuman. So these women wanted to give birth on their own.

Most of the women who contacted me felt strongly that they did not want to wear a mask during labour; they did not want their partner or doula to be restricted; they do not believe that the Covid vaccine is necessary or valuable. The vaccine passport in Quebec is now required for a doula to accompany a woman to a hospital or birthing centre, and this is also part of the reasons why this group of women are seeking answers elsewhere.

My life has been devoted to a few things: my own family - my husband, my five sons, and their new families; my attempts to live a good life; and my desire to facilitate change for women, their children, and the world as a whole. For me, that desire became focused on working to find ways to make decent, safe, respectful, woman-centred health care available for every woman. 

So when women started calling me and wanting my assistance, advice, and companionship, I agreed that I would provide prenatal support - virtually - and I would accompany them along their decision-making paths to childbirth. You know what? That's insane, and reckless, and lacks consciousness, and that's why I believe that I somehow, somewhere, lost my center. The paradigm doesn't work. Because prenatal care is about touch, and attention, and the five senses, the sixth senses, and all the senses in between. Common sense, for one. 

If a woman wants to give birth on her own, for whatever reason, I actually support her in that choice. I don't like to tell people what to do, generally. But I also like to hold people accountable for their actions. And that means that if you're giving birth on your own, then you don't involve me. Why not? Let me explain: I've had many calls from women who want to give birth "outside of the system". And they want me to be a "fly on the wall." Why would they want that fly there? "In case anything goes wrong". Well, the fact is that, in fact, things DO go wrong during childbirth. And if you're giving birth on your own, you should recognize that and figure out what you're going to do in that situation. 

But it's not right to rely on the knowledge and experience of a fly, and it's not right for a doula to offer to be that fly. Because then when things do go wrong (which, yes, is very, very rare), then what's a fly supposed to do in an emergency? 

I'm taking time away from some things for the next little while, and I don't even know which things. I will be making some time for myself: time to think, to ponder, to meditate, to run, to declutter, to find peace, to find my center again.

Midwifery and Bullshit

 

These are not midwifery tools, but they could be. 

I have started offering prenatal support and consultation to women who are looking to give birth in an autonomous way. Several of these women are being followed, or have been followed, by registered midwives here in Canada. I've also spoken to a few practising midwives in this country, and I believe our midwifery establishment is in crisis.

We were an unusual country. Midwifery was illegal in all of our provinces and territories until the 1990's, when provinces started to recognize that it would be useful to register and educate midwives in the medical model. During the twenty years from the 1970's until midwifery was legitimized and regulated, midwives worked illegally to assist mothers at home, and there were a few midwives who were charged with practising medicine without a license. 

During the 1990's, midwifery became regulated and legitimized in several provinces. Midwifery education programs were developed and offered in universities across the country. These programs were very hard to get accepted into, and required a formal academic background over life experience. Most of the original lay midwives who had been practising illegally before legislation were "grandmothered" in to the Colleges of Midwives, but the applicants who were accepted into the programs were generally younger and obviously less experienced. 

Midwives were and are in great demand. The supply is very limited, partly because of the restrictions that competitive educational options and limited employment options mean for anyone who is drawn to the practice. Provincial governments in Canada have succeeded in effectively reducing the number of potential practising midwives, either with restrictive educational possibilities, or by limiting the ways that midwives can practice.

Because of the lack of registered midwives, and because the available midwives were practising in the medical model, several women over the years in various provinces in Canada chose to give birth either unassisted or with Traditional Birth Companions. As well, midwives trained in the US or elsewhere started offering their services as midwives and attended women at home. This was risky, because with the creation of a College of Midwives, anyone offering restricted practices under the provincial midwifery acts could be (and were!) prosecuted by the provincial College of Midwives. So far, this has happened in B.C., Saskatchewan, and Quebec. 

The pandemic of 2020 changed the face of birth. Women who were hiring doulas to accompany them to their hospital births found that the hospital authorities had full power to limit the number of people present, and doulas were left at home in front of their phones, providing encouragement, support and continuity of care from afar (Hats off, shout out, Kudos to all you doulas out there!!!). Home birth was restricted or banned in some areas, and midwives were given even more rules and regulations they had to practice under. 

Hospitals were seen, rightly so, as places for sick people (hmmmm, isn't that what they always were?). A few women, certainly a larger number than in 2019, decided that they would give birth on their own. Others decided that they would continue with midwifery care and fill in the gaps with the council and support of other practitioners.

Here is a little account of what is wrong with midwifery today, gleaned from conversations I have had with women seeking answers, and why I believe it has gone wrong:

• Newborn mothers and babies do not need immediate testing. They need skin-to-skin togetherness, if the immediate indications of their health is good.
• Newborns do not have to latch on the breast like a champion within the first half hour of life. Again, they need skin-to-skin togetherness. Mother will need to eat and drink. Attendants should stick around with gentle attention.
• If you say that you will offer a woman attendance at her home, and you visit her home and bring equipment and preparations ... she is not going to hear your quid pro quos and fine fine print at the bottom of your conversations. She will be deeply disappointed when you tell her that (for whatever reason, that has to do with YOUR infrastructure and organization of lack thereof) she cannot after all birth in the comfort of her own home.
• Women over 40 are not inherently dangerous. They can carry a baby to term and do not need extra testing or worrying conversations about how risky their pregnancy is. That's why she chose you, a midwife, so they wouldn't have to be bullied.
• Midwives have to learn to keep their faces pleasant. So many women have let me know that they got really scared when they saw a young midwife look at their lady parts with horror/fear on their face. A vulva or a newborn's head can look wildly psychedelic, but usually is no reason for alarm.
• The word "should" doesn't belong in your vocabulary if you are attending a birthing woman. 

Women now, a small percentage but nevertheless a percentage, are choosing to give birth at home autonomously instead of seeking the attendance of a midwife or a physician. This fact makes me sad. Why? Because I believe that every woman deserves a safe and sacred place in which to birth her child. Some women want to birth in the hospital. That birth should be as respected and loved as a birth that takes place at home surrounded by a circle of women. Some women want to birth at home, and these women deserve respectful, kind, reliable, and legal midwifery care. 

There is work to be done!!!

Safe Birth Take Two

A couple of weeks ago one of my dear friends gave birth, at home, surrounded by her family and small community. She is a paragon of strength, but also a tower of gentleness, and she's funny, athletic, and creative. Her first son was born in the hospital, and from then she knew that she wanted to birth at home, without interference, peacefully.

I do know that the way she gives birth is not for everyone. In fact, the birth reality that I envision is very different from her reality. I see women giving birth in all sorts of ways, attended by all sorts of caregivers. But the most important thing about the birth experience will be that the woman giving birth is at the very centre of the experience. She is giving birth; it's her body, and she makes the decisions.

I've been talking to a lot of women lately, and I'm hearing some shocking stories. Don't misunderstand: I know that there can be mistakes, sometimes tragic and foolish ones, made by women and their caregivers who try to create more caring, gentler paradigms about birth. Believe me, I know that Nature is far from gentle; that babies and mothers can die; and that modern western medicine can and does save lives.

But, and this is the most fundamental and important thing, there exists in our maternity care system a systemic and pervasive misogyny that allows maternity caregivers to debase, abuse, destroy, demean, reduce, insult .... the women who come to them for care ... and this has to be ended! 

This systemic sexism is linked, of course, to the racism that we see around us to create a poisonous brew that is literally killing black women in the US (https://www.nationalpartnership.org/our-work/health/reports/black-womens-maternal-health.html). 

In the past week, I've spoken to women all around the world. I've heard tragic and disgusting stories. Doctors are doing unspeakable things to women. Doulas and midwives are deciding to leave at random times, women are being left alone when they most need attendance. It should be no act of bravery to bear a child. What I mean, is, of course it is a brave and courageous act to make the jump to bear a child, but that act should not be met with conflict and derision on every front.

"They didn't even look at my birth plan."

"My midwife went out of the country."

"They botched the c-section and told me I could have a VBAC, but I couldn't because they had made a hole in my cervix."

"The midwife left when I went into surgery."

"The nurse broke my bone."

"I told them it still hurt but they didn't believe me."

"The doctor jumped on my stomach."

"They wouldn't tell me what was going on."

"They didn't believe me when I told them the baby was coming."

"They didn't believe me when I told them I was in labour."

The are real women with real voices, telling real stories. They suffer immense trauma and feel pain, and grieve their loss of self-esteem. And do you know what they do? They love their babies, and raise their children, with love.

Women deserve more. Speak out! Let's start to talk about our experiences ... it's time to stop the slaughter of birthing mothers (literally, in the case of Black women). It's time to birth on our own terms. We need to seek out birth attendants who put the birthing woman at the centre of the birth event; who treat women as they are: the bearer of children. The vessels of life. The nurturers of our babies.