Unassisted Childbirth

I wrote this post about ten years ago ... nothing much has changed in the system, but we are seeing a growing number of women choosing to birth outside the medical system.

Back in the good old days, when I was a subsistence farmer in paradise, I had a friend who told me her birth story. This was before I started working with birth, but not before I had already started studying and learning, and listening to women's stories.

 

Friends Sharing Birth Stories

My friend's first baby had been a breech who did not want to get her head down. The policy at that time in Italy, as in many places, was to deliver breech babies by cesarean section, especially if the woman was a primipara.

So, my friend had a c-section, and she did not feel good about that birth at all. She thought that it was probably possible to give birth to a breech baby vaginally, and she felt pushed into making a decision that did not feel right to her. She decided she didn't want to go back to the hospital again to give birth.

She became pregnant again, and decided to stay at home this time and give birth on her own terms. She looked for a homebirth midwife but at that time in Italy they were a rare breed, especially if you were living in the hills as all us organic subsistence farmers did. She prepared by reading about natural birth, and she made sure she had methergine in the house - they always had it on hand for the goats.

Labor started and she sent her husband and child out for the day. She didn't want her daughter present for what she knew was going to be an intense and possibly scary event.
This was before cell phones, and they didn't have a phone, so he planned to come back around suppertime. She labored on her own and late in the afternoon, gave birth to a healthy baby.
"Were you scared?"
"Yes, I really wanted to have someone else around. I remember when I started pushing, and I felt a cervical lip, and I gently pushed it out of the way - I really wanted someone to be there with me. But I knew everything would be okay - I had a feeling. And if it wasn't ok, then it wasn't. I did it my way."

There is a growing movement that promotes unassisted childbirth as a way to regain control over your own birth, and there are many valid reasons for not wanting anyone at all from outside your circle of family and loved ones to be present at the birth of your child. It is, after all, a natural event, more like lovemaking than like a medical procedure. The presence of a stranger, even a well-liked one, can change and disturb the process. Midwives can be regulated by laws that perhaps don't agree with a woman's perception of how she wants her birth to proceed. 

I often get calls from women who are planning to give birth without attendants. They want information, or they want to find someone to be a "fly on the wall" - who can be there "just in case". Most of these women are women who have not been able to find a registered midwife - either they didn't call early enough, or they live in the wrong area, or they are considered too high risk for a homebirth. They don't really want an unassisted birth, but they are committed to not wanting to go to the hospital unless they really have to, so they are left with unassisted birth as their only option. Because we Canadians are used to free health care, cost is also a consideration. Unregistered midwives charge around $2000 for prenatal, birth, and postpartum care (that works out to about $10.73 an hour, in case you're wondering). Many women do not feel that this amount is an option, and, again, make the choice to give birth "unassisted".

I firmly believe in a woman's right to choose what's best for her body, and for her life. If a woman chooses to give birth on her own, or just with her partner, or her sister, in her own home, then power to her! She is making an adult choice, and she is accepting responsibility. But I do feel sad when women want to have the care of a midwife and cannot.

No woman should have to give birth on her own if she doesn't want to. Midwifery care should be available, really available, to any woman. Homebirth should be an option for us all. Unassisted homebirth is only one option, but it should be an option that is actively chosen and not decided on for lack of other plans. Equally, hospital birth is only one option. Health women carrying healthy babies should not have to go to the hospital to give birth unless they actively want to. Informed choice should be a reality - it should be informed, that is, women should educate themselves and each other, and they should ask for informtaion from their care providers. And choice should be a real choice with real options - unassisted, home birth, midwifery care, hospital birth.

Let's work together to bring the woman and child back to the center of maternity care!

Birth Uprising Manifesto

I have been thinking a lot about my basic values, and I've come to the understanding that these five simple words spell out my goals, in terms of my life work with families through the childbearing year, and specifically with women through their reproductive life journeys.

Safe and Sacred Birth Choices.

Let’s start at the end and work backwards to the beginning!

1. Choices

2. Birth

3. Sacred

4. and

5. Safe

1. Choice

Choices are so important! And in our reproductive lives these days, we do have many, many options and choices. But sometimes we’re presented with choices that we feel have been already made for us, or we don’t understand what choices we have. This is where the idea of informed choice comes in.

Informed choice and informed consent are often used together in a medical setting, but they’re not the same at all. Informed consent means that you’re agreeing to something that someone has explained to you. I said yes to something that you kind of explained was an absolutely necessary thing I had to do.

Consent means I said yes. The informed part can be really vague.

Informed choice can mean that too, but real informed choice means that all of the options are explained to you so that you fully understand them - and their consequences. And then you can make a choice.

A real choice. And that choice, just like in what we like to call consensual sex, might be “no”. "No", I don't want to have a child right now. No, I don't want to be induced. No, I don't want you to do that.

I want choices to be informed, respected, and real for women during their reproductive lives.

2. Birth

Well, birth is where we all come from so it’s pretty important. But birth choices, for a woman, can also mean making the choice not to give birth. Ever. Or not to give birth right away. Our choices around birth start with whether to have a baby or not and move through the whole process after that choice has been made, and beyond.

If you decide to have a baby, then the complex choices start: where will I give birth? Who do I want with me during this childbearing year? How do I want to be treated while I am pregnant and birthing? Why am I being offered this medical choice, or another one? When will my baby arrive? Can I decide when I’m going to give birth? Why does my labour not start? Why does this hurt? What should I do?

There is so much education and respect that is not available for women during their childbearing year.

I want every woman cared for with respect, humility, love, and compassion.

3. Sacred

The word sacred can mean different things to different people. Lots of you might feel some resistance or annoyance with the word. That’s okay. Except that this word might be a key to understanding the childbearing year, women’s reproductive life, and even life in general in a different way. In a way that recognizes and affirms that we are not ultimately in control, that there is something bigger and more wild growing and living through us. Even if it’s chemical reactions, or hormones, or nature (whatever that is) or Spirit, Creator, Universe or God…. if we start to imagine that we aren’t the captain of this boat, ESPECIALLY if we are attending a woman during her childbearing year, then that humility will lead us to a place where we can actually provide better care. If we understand that the body isn’t just the body, and it is made up of physical things and also things that we can’t really name, like emotions, intuitions and thoughts. And that the body and those more unnameable things work together to make not only that human being you are accompanying, but also yourself; So that we come as humans to assist, to attend, to accompany other humans, but never as a higher power or an authority.

Sacred care in birth leads to better physical outcomes, happier babies, happier mothers and a better world.

4. and

"and" can open up so much possibility … I just included it because it’s one of the five words …and why shouldn’t a simple conjunction mean as much as another fancier word? And for me, this is the truth of working with women throughout their reproductive life; again, it’s a question of humility. Who am I, fancy person with years of study, to think of myself as fancier than a simple person who has asked for my assistance? If I decide that she can no longer teach me anything, then I’ve closed the door to real healing. That little word “and” can teach us a lot: it’s a little insignificant word but it binds the two parts of the sentence together. Like love.

Every birthing mother deserves to birth in love.

5. Safe

I’m not going to talk right now about the dangers of childbirth. Just ask Dr Google and you can scare yourself silly. I won’t tell you all the scary statistics or tell you the horror stories. But what I will tell you is that our maternity system, the global maternity system that we have in place right now, is hurting women and babies. The affluent women are surviving technology-led birthing practices that take no account of the whole human beings in front of them. The less affluent women, and the black and coloured women in the US, are being treated worse than animals and are being denied decent care, either because of poverty, racism or both.

I want a maternity care culture where the safety: physical, mental, emotional and spiritual, safety of the woman who is birthing the child (or children) is the absolutely most important thing in the world at those moments, for the people attending her.

I am working hard towards this goal.

This week, I’m crying for the mothers I’ve served. The details aren’t necessary for now but I’ve spoken to six women this week; one with a tragedy; one with rage against her doctors; one with a potentially fatal diagnostic error; one with a natural birth that was interfered with; one is expecting to birth alone; one setting her boundaries hard and high.

Women shouldn’t have to fight for their right to have good, respectful care during their childbearing year.

My demands are:

Birth attendants (doctors, midwives, nurses, doulas), do you know that there is a whole movement of women who don’t want to be cared for by you, because they don’t want to be treated badly? They are not children, they are humans with whole lives, and they want to be able to make choices that may be different from yours. These women also deserve SAFE care. Here are some suggestions:

Take some lessons in self-care. This is not an option. You can’t care for others, especially for those who are bringing a new life into this world, if you do not care for yourself.

Cultivate your ability to love others. Love is not an option. You must love the woman you are supporting.

Leave your ego at the door of the birthing room. No, you are not in control. No, you are not the captain, and, no, the buck doesn’t stop with you. You are an assistant, a vessel, maybe even a highly trained one. But your job isn’t to provide judgement.

Be honest. If you don’t want to take extra time before you reach in with an intervention, take the time to explain why and ask yourself honestly if you know what the consequences would be if you waited. If you’ve never waited, and there are no studies to show what happens when you wait, then it’s all superstition and you don’t really know. If you say, “I’m not comfortable with not waiting, but there are no studies to back me up” then a dialogue can begin. If you say, “We have to do blah blah or your baby will die.” then there’s no dialogue, just fear and power and ego.

Be curious. Maybe some of the methods and theories suggested by others are actually valid. Have a look; open your eyes; don’t do a knee-jerk “NO!”. This goes for all of you – I’m not targeting doctors here. I know enough alternative practitioners who are quick to judge as well.

Be attentive. Medical practitioners have forgotten how to be attentive with their senses, and not with their machines: Sight, smell, touch, listening are the four senses we use (and we leave taste for dinner!). And intuition, and the important sense of humour! I don’t know of any kind of healer, where they’re a specialist with sixty years experience or a beginning midwife, who does not value the kinds of messages their intuition will give them, if they’re open.

Listen to the woman who is birthing. Who is she? What does she want? What does she know?

And here's some advice for all you women out there, trying to navigate the realities of your reproductive lives:

Be curious. Ask around and find the path that suits YOU, not your friend, your mother, sister, or even your partner.

Learn and keep on learning. Knowledge is power!

Reach out! There is a whole world out there, and there are people who might be able to give you the answers you are looking for.

Don’t be shamed! Whatever you choose for your journey is your very own choice, based on who you are, who you were and who you will be. Whether to bear a child, where, with whom, and how are all personal choices that don’t belong to anyone except you and your partner. If you feel shamed by a friend, a group or a professional, stay away!

Listen to your body.

Demand choices! Demand your rights! Don’t be bullied, even when you are labouring. If something doesn’t feel right, stand up and say no! If you can’t do that on your own, then hire a doula. If you can't afford a doula, find a free one! I guarantee you I will find you a free doula if you want one…

Know that we love you! Find a community, we are around.

For more information about Birth Uprising, leave a comment or reach out, you can find me!

Love, power, peace and love again.

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!

Unassisted Childbirth

Back in the good old days, when I was a subsistence farmer in paradise, I had a friend who told me her birth story. This was before I started working with birth, but not before I had already started studying and learning, and listening to women's stories.

Friends Sharing Birth Stories

 My friend's first baby had been a breech who did not want to get her head down. The policy at that time in Italy, as in many places, was to deliver breech babies by cesarean section, especially if the woman was a primipara.

So, my friend had a c-section, and she did not feel good about that birth at all. She thought that it was probably possible to give birth to a breech baby vaginally, and she felt pushed into making a decision that did not feel right to her. She decided she didn't want to go back to the hospital again to give birth.

She became pregnant again, and decided to stay at home this time and give birth on her own terms. She looked for a homebirth midwife but at that time in Italy they were a rare breed, especially if you were living in the hills as all us organic subsistence farmers did. She prepared by reading about natural birth, and she made sure she had methergine in the house - they always had it on hand for the goats.

Labor started and she sent her husband and child out for the day. She didn't want her daughter present for what she knew was going to be an intense and possibly scary event.
This was before cell phones, and they didn't have a phone, so he planned to come back around suppertime. She labored on her own and late in the afternoon, gave birth to a healthy baby.
"Were you scared?"
"Yes, I really wanted to have someone else around. I remember when I started pushing, and I felt a cervical lip, and I gently pushed it out of the way - I really wanted someone to be there with me. But I knew everything would be okay - I had a feeling. And if it wasn't ok, then it wasn't. I did it my way."

There is a growing movement that promotes unassisted childbirth as a way to regain control over your own birth, and there are many valid reasons for not wanting anyone at all from outside your circle of family and loved ones to be present at the birth of your child. It is, after all, a natural event, more like lovemaking than like a medical procedure. The presence of a stranger, even a well-liked one, can change and disturb the process. Midwives can be regulated by laws that perhaps don't agree with a woman's perception of how she wants her birth to proceed. This site provides some interesting information about unassisted childbirth:UC

I often get calls from women who are planning to give birth without attendants. They want information, or they want to find someone to be a "fly on the wall" - who can be there "just in case". Most of these women are women who have not been able to find a registered midwife - either they didn't call early enough, or they live in the wrong area, or they are considered too high risk for a homebirth. They don't really want an unassisted birth, but they are committed to not wanting to go to the hospital unless they really have to, so they are left with unassisted birth as their only option. Because we Canadians are used to free health care, cost is also a consideration. Unregistered midwives charge around $2000 for prenatal, birth, and postpartum care (that works out to about $10.73 an hour, in case you're wondering). Many women do not feel that this amount is an option, and, again, make the choice to give birth "unassisted".

I firmly believe in a woman's right to choose what's best for her body, and for her life. If a woman chooses to give birth on her own, or just with her partner, or her sister, in her own home, then power to her! She is making an adult choice, and she is accepting responsibility. But I do feel sad when women want to have the care of a midwife and cannot.

No woman should have to give birth on her own if she doesn't want to. Midwifery care should be available, really available, to any woman. Homebirth should be an option for us all. Unassisted homebirth is only one option, but it should be an option that is actively chosen and not decided on for lack of other plans. Equally, hospital birth is only one option. Health women carrying healthy babies should not have to go to the hospital to give birth unless they actively want to. Informed choice should be a reality - it should be informed, that is, women should educate themselves and each other, and they should ask for informtaion from their care providers. And choice should be a real choice with real options - unassisted, home birth, midwifery care, hospital birth.

Let's work together to bring the woman and child back to the center of maternity care!