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.

Belonging and Ur: Thinking about Home

"You finally leave home, the Ur of we, and you find another we? Another place that's just like that, the substitute for that?" *

I know so many people who are drawn to a place. They consider it their home. I've never had that feeling about a place. Yes, I loved the smell of the market in Kampala when I returned 20-odd years later. I'm guessing it stimulated something in my amygdala that my lizard brain appreciated. And I do love the Rockies, as you all know. I love remembering the feeling of being young and fearless, and I love the feeling of recognizing how tiny I am in the bigger scheme of things. Oh, and I love hanging out in my house in Montreal, I love the couch, I love the smell of patchouli in the air from my morning baths. 

But drawn to a place? Having roots, like a tree or whatever? Not for me. I yearned after it for years. I ran to Africa and traipsed around there for a couple of years, trying to imagine myself at home. I joined various communities: the radical feminists, the Left, the Ultra-Orthodox Jews, the underground midwives. I created a large family and I generally feel "at home" when I'm with my kids and their spouses. I always feel at home with my baby grandson!!!

And I always feel at home when I out there running, placing one foot on the ground, then the other, then the exact same thing, over and over and over again, the farther the better. And I feel at home when I'm curled up on my couch, reading a good book. Or when I'm on a trip, going somewhere in a car or a train or a boat or a plane. In the Sahara desert in a truck. In the mountains of Morocco with a young girl who's leading me to a cool mountain stream. 

But I digress. These are all the places I've been ... not really places I actually could call my home, in any true sense of the word. Although maybe .... maybe what I feel is home just ain't what you feel is home. Maybe my wanderlust is deep, so deep that only when I'm moving do I feel "at home". That's why I speak English with a kind-of British accent; French with an Italian accent, Italian with an English accent and a couple of words of Hebrew with a Canadian accent... it's why I can have wonderful conversations with people who I've never met before, and with whom I don't share a language. We use sign language, love, and a willingness to understand and be understood.

I've met many people over the years who have had to flee their homes to settle in a completely new place. I've met families with young children who left a home that was destroyed, who walked for miles only to get on a leaky boat, and if they survived that they walked some more and then had to live in a tents for months and then they could start their new lives in a new country... and they always had their old home in their hearts, even if they knew they would never go back. 

I dream about the house I spent most of my childhood years in. But I don't look back and think "ahhhh, home." But if I just remember a feeling that I had in the back of a truck in Saskatchewan when I was fifteen, and I could feel the wind in my hair and I had no idea what was coming next ... "ahhh, home". Home, for me, is the movement from one place to another. It is never "we". It is always "I" and it can get lonely. I share my home with others - my husband shares it, and my kids and their lovers and my grandson. It's a big tent, but a moveable one. A nomad's home. A snail shell.

When I'm assisting a woman giving birth, one of my many goals is to create a "home" for her, for her baby, and for her circle. I do this in many ways: sometimes with my physical presence, sometimes with my knowledge, sometimes with suggestions for her about choosing her team of support. Giving birth to another human is about one of the biggest transitions a person can make, so if I can facilitate a feeling of being "at home" through that transition, I have done my job well. To clarify, when a woman is "at home" during her birth-giving experience, she feels as if she is at the center of that experience, which is exactly where she actually is. Many maternity situations these days successfully pull a birthing mother away from that center, and away from that home. Whenever she is told that she "should" or "shouldn't" do something; whenever she is made to feel ignorant or foolish; whenever she understands that she hasn't somehow lived up to other peoples' expectations of her, then a birthing woman will feel exiled from her home and pushed out of the center of that primal experience.

And I want to make clear that I am not saying that it's only experiences that are within hospitals, or with OBGYNs that can make a woman an exile in her own birth experience. It's more common within these institutions, for sure, but then again the majority of women now in Canada are giving birth within institutions. I am saying, however, that WHOMEVER and WHENEVER and for WHATEVER reason a birthing mother is spoken to, she must be spoken to with respect, with humility, with honour. There are social media influencers who are shaming women every single minute, with "facts" about her birth choices and her life choices that are just not true. There's a whole world out there full of people who want to drive a birthing woman from her home, by imposing their own personal choices upon her. 

We all need to find a home where we can dwell with some measure of peace. When babies are born in environments of fear or anger, they don't feel that peace. Good things can come from stress and desperation: women who have been torn apart are now trying their very best to repair and heal the birth environment for others to come. I love to do a big huge houseclean every so often: where everything is turned upside-down and cleaned before it is put back in its rightful place. I air everything out, make things smell nice, repair broken things, clean underneath.... maybe we need to do a little housecleaning! 

Please reach out if you want to be part of the new birth attendant course @mbcdoulaschool!

*from Philip Roth's masterpiece The Human Stain. 

Home Can Be A Tower

I'm thinking a lot about home, and what home means to us. We moved our family to a medieval tower in 1988: it was the beginning of a long series of adventures, some cool and exciting, others devastating and dangerous. I pulled the Tower card this morning for my reading, which can mean change in a fundamental way. It can mean the destruction of one home and the creation of another. It can signal the breaking down of old habits and patterns to make way for new: an eruption, a revolution.

I work alongside women who are thinking deeply about how they want to give birth. Most of them want to birth at home, and many of them do. Last week, one of the women I have been working with over the summer gave birth at home, peacefully, in her place, with her partner alongside her. She came back to the city from abroad because she felt the need to give birth "at home". She didn't just mean in her own apartment, on her own bed. She meant "in her home". She missed the smells of her city; the bicycles; the streets and trees of the place she knew - she knows - as her own home.

When I am invited to accompany a woman during her reproductive experience, whether that is pregnancy, birth, miscarriage, abortion, infertility experiences, or the decision whether or not to have children, I try to facilitate a way that she can work her way back to her "home". We all have a centre place, a home, that we need to be able to return to. When we can't return, we get lost. We get lost in other peoples' needs and desires. We get lost in addictions. We get lost in our jobs. We get lost in cleaning up. We get lost in the search for money or new things. We get lost and then the Hungry Ghost finds us and we feel empty all the time, and hungry, and we don't even know what we are hungry for. But the answer is, we're missing our Home.

I've never felt I had a geographic home. I moved from one continent to the next all my life: Africa, North America, Europe. I love the Canadian Rockies. I feel at home when I'm on a trail. I love the desert. Give me temperatures at body temp or higher, and I'm happy. Then again, I love the challenge of a 20 k run in 20 below zero. 

But I wouldn't say I have a home, like, I don't feel "at home" anywhere. I am at home when I'm with any number of my five children and their spouses. I'm at home when I'm running a long distance. I'm at home ... when I'm on a plane, looking down at my planet.

I listen with awe to people who speak of missing their home, how they miss the taste of a place, or the feeling of the wind on their faces in their home place. My journey is different: because I've never felt the geographic pull of home, I seek to find my centre, and I accompany others on their own journeys to their centres. When a woman is birthing in her centre, she is birthing at home. When she gives birth in her power, at the centre of the event, she has found her home. My job is to navigate with her so she can find the path home. Sometimes there are huge prickly trees in front of the entranceway. Sometimes her home is very small, so small she can trip on it at night. Sometimes she needs to lose something in order to find her home. Sometimes she needs to let go of one place to journey to the other.

Peace.

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.

A Day in the Life of a Doula

This is a story about three women: two doulas and a laboring mother.

The mother's labor started in textbook fashion at 39 weeks, twelve hours after she had some light bloody show. She spent the day alone, enjoying herself and feeling crampy contractions every ten minutes. When Doula "A" finished work she slowly headed to the woman's home where they had tea and "chilled". Her contractions were becoming slightly more intense but our client was still chatting, making tea, and having a good time.

The textbook went a bit sideways at this point, when our lady decided to have a nap. As she lay down on her side, her waters broke and she felt the urge to push. Doula "B" happened to arrive at that moment and they quickly got into the car and drove to the hospital.

When they arrived at the hospital, they were of course whisked through to a room, and our lady was undressed and invited to get onto the bed. She did so, and continued to push. At this point, the resident tried to find the heart beat for the first time and was unable to. The baby crowned, the resident performed an episiotomy, and a very healthy baby was born.

The medical staff were very angry with the doulas for "letting" our client stay at home for too long. The new mother asked why she had been cut, and was told that the physician was concerned about the heart beat.

She was discharged the next day.

One of the doulas said afterwards:"That would have been a seamless homebirth." Yes.

My question is, what is your take on this?

Should she have come in when her labor started?

Should her doulas have done a vaginal exam? (A rhetorical questions, really, as they are not trained nor allowed to do so).

If she didn't have the support of a doula, then she would probably have come in earlier (here I am trying to convince myself that our services are unnecessary).

Thank you for your time, and appreciating in advance your comments,

Rivka

Seven Billion!!

I heard today, as many of us did, that the world's population is estimated to have reached 7 billion people!

Let's not speak of low resources, climate change, and gloom and doom, but let's celebrate this 7 billionth baby's birth with a cheer and a toast, to good health, happiness, and longevity for us humans. I'm sure we can find a way to make it all work.

More interesting to me is the likely fact that this baby was probably born at home, with the attendance of a traditionally trained midwife. I do not advocate going back in time to the days when women died in childbirth, but I do believe that home is the best place to conceive and the best place to give birth. I offer a vision of birthing the future from my book:

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 each woman 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. My job as a doula is to create a space in which a woman can reclaim her knowledge of birth and give birth according to her own birthright.

Illegal Midwives part 2

 The bureaucracy in Quebec has decided to remove another hurdle for women who choose to give birth at home without the support of a registered midwife. There aren't enough birthing centers or registered midwives to go 'round, so more and more women are giving birth "unassisted" or with the attendance of an unregistered midwife.

The women who choose to have their babies at home with  "illegal" midwives pay a price: registered midwives are free, paid for by provincial medical insurance. The other midwives charge around two thousand dollars for their services, which is a great deal as it includes sometimes months of prenatal care, personalized and attentive labor and birth attendance, and comprehensive postnatal support.

They also pay with hours of bureaucratic nonsense, when it comes to getting their new baby a birth certificate.
It may be that raggedy old hippies or sneaky foreigners on tourist visas come to mind when you are imagining the women who choose this route. But they are more often highly educated, professional women who are used to doing things "their way" and do not want to go outside their own home to give birth.

I have heard stories of women being threatened with the police and child protective services if they did not present themselves and their hour-old baby at the hospital to do their paperwork.  This new directive is a small fairy step in the right direction:
Quebec bureacracy