Birth (and life) after Cesarean

I love to listen to birth stories. Many of the stories that I hear are a testimony to the pregnant woman's great ability to "animal out" on her attendant. My favorite is the story of a young woman who had her first daughter by cesarean section She became pregnant again the same month and it turned out she was carrying twins. Her doctor was very alarmed and booked her for a cesarean at 38 weeks, She went into labor at 36 weeks and delivered two lovely girls, vaginally.

Of course, women who are trying for vaginal birth after cesarean don't always have such fine stories to tell. Two remarks have stayed with me over the years, and these were both delivered by obstetricians to a laboring woman. The first was: “Childbirth is like war, and I am on the front line.” The second: “This is Monday morning in a busy hospital. There are road accidents, emergencies …” This was said to a woman who wanted to labor a little more before the decision was made to go to surgery, implying that the birth of a child had to be scheduled in somehow between a messy car accident and some other horrific case. Why did this man want to become an obstetrician? How did he feel about his "patients"? How had he been born? What was it about birth that suggested to him images of war?
What is it about childbirth that makes these people think in terms of war, car accidents, death? Is it just fear? And if it is, what exactly are they afraid of? And , more importantly, where does the midwife fit into this mosaic of fear, or does she fit in it all?

Doctors and midwives who are afraid of childbirth are partly afraid because of their training. Allopathic medicine teaches about pathology rather than the whole healthy being, and pregnancy is often seen as a pathologic condition. But there is another more profound reason for this fear, and it has to do with the fact that Western medical training teaches health workers to rely only upon their own knowledge. How does this lead to fear?
Let me explain. During childbirth there is something present that is outside of us as individuals, out­ side our knowledge, even outside our experience or our skill. That "something" has to do with faith. It is only with a leap of faith that you can appreciate or even accept that a new human being comes out of a woman's vagina. Without that leap of faith, what happens? Two things: more obviously, you have to interfere, pull it out, cut it out another way. But another thing happens as well. Strangely, your faith (most of us have faith in something) gets turned inwards. As an obstetrician, you have faith only in your own skill. And that is what is frightening-- that an event which cries out for the presence of God gets reduced to the simply human.

I'm sure that there are obstetricians who works differently, but I think that it is easier for a mid­wife to accept that there is something else, something larger than herself, working through a birthing woman. It is quite noticeable how many mid­wives are religious, how many live in sight of that something which many people call God. But what happens to the sympathetic midwife working within the medical system? What happens to her sensitivity to that Other which touches us when we give birth?
I have met many diverse people over the years of working with birth.I have encountered some women who probably disliked their work, who were overtired, overworked, who had little faith in any­thing. I have also encountered mid­wives who have accepted modern medicine's vision of birth. And I have met many brave and gentle souls doctors, nurses, midwives, and doulas, who are working within the medical sys­tem and trying to maintain their faith at the same time.

What do we see in a hospi­tal? We see, first of all, an exagger­ated reliance upon technology. We know that the use of technology has a snowballing effect, creating the need for more and more complicated interventions. Secondly, we see a rigid hierar­chical structure in which usually one person is calling the shots. Finally, we see the "spiritual" infrastructure upon which this hierarchy is based, to be inward looking and grounded only in human knowledge.
What happens in the hospi­tal when things start to "go wrong," when things don't follow the pre­scribed path? When I went into the hospital in labor with my first child, the nurse, who was actually a mid­wife trained in Scotland, touched by belly and said cheerfully, "This baby will be born by noon." As time went on, she touched me less and less. By the next morning at the start of her shift, she didn't even greet me. As they let me eat and drink less and less, my cervix grew smaller, I was touched less and I began to feel more and more isolated. I was touched only when necessary. The baby's heart­ beat was checked less often. I began to feel abandoned.

Can I offer some advice to birth attendants working with women who are hoping to give birth vaginally after a cesarean section? Remember that the previous cesarean(s) have left scars not so much on the uterus as on the woman's sense that she is capable of giving birth. Accept that having a cesarean can hurt. Please don't de­scribe to her how a ruptured uterus may feel. Watch for danger signs yourself. Keep your concerns to your­self as much as possible. Remember "failure to progress" can be linked to fear and stress.
Keep things easy even when they get hard. Remember that a woman work­ing for a VBAC needs the comfort and security of her own home. Remem­ber that she may need to work on building confidence, on throwing away fear, on finding her "animal" self. Re­member as well, if it turns out to be another cesarean, don't abandon her. Give her the support through the birth and afterwards that you give any birthing woman. If a lady has another cesarean, she may feel very low; it may help her to talk to another mother who has been through the same thing. Avoid the mistake of "You're lucky the baby's okay.That's the important thing." Yes it is, obviously, but ... she may still need to grieve.

I am lucky - I have been blessed to have attended many successful VBACs during my years as a birth attendant. Thank you, again, to all the women who have shown me how fearless and strong birthing women are - not least, the woman who have said "Yes, I am ready for surgery, of course, if my baby's life is in danger."
Here's to a happy marriage of modern medicine and safe midwifery, with lower cesarean section rates and happier and healthy mothers and babies. L'Chaim! To Life!

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!

Rest, Recovery, Reflection, Renewal?

I am sitting on a hilltop in northern Italy, rather completely on my own. My dog is here. I'm surrounded by insects, animals (deer, wild boars, the odd wolf, badgers, and all that). I planned for a very active summer, running at least 40 k a week, which I love doing - running long distances is literally my happy place. But then some stuff happened and I got Covid and now I just feel cellularly tired. So every day I spend quite a few hours just sitting staring out at the view. 

And what I've been asking myself is that difficult, age old question: Who Am I?

When you spend hours alone, especially in a spot where silence is the overwhelming sound, you get a chance to really "dig deep" and find out what your questions are. I can't really believe that I have been inhabiting this body and mind and soul I guess for nearly 66 years and I still don't really know who or what I am. So, let me start at the beginning, well maybe not that far back but ... 

Names

I guess you all know the story about how Toni Morrison got her name. Toni she decided on herself, after converting to Catholicism at age 12 and naming herself Anthony. Morrison was her husband's name and she was stuck with it because when her first novel was published she was still using it as her legal name even though they were already divorced. There's an quote floating around from 1992 that goes like this: 

"I am really Chloe Anthony Wofford. That’s who I am. I have been writing under this other person’s name. I write some things now as Chloe Wofford, private things. I regret having called myself Toni Morrison when I published my first novel, The Bluest Eye.”

Well, the same kind of thing happened to me. I'd always been Niki, or Nicky when I was very young. Or Nicola when my parents were mad at me. Then in my forties I had a brush with religion - not Catholicism - and I was persuaded to change my name. So I changed it to Rivka, a name I don't even like that much, but who gets to pick their own name. And then my work as a doula, birth companion, teacher, author and my whole birth persona grew wings under the guise of Rivka Cymbalist and there I was, and here I am, just like Toni Morrison (ha!).

So, for now, Niki is reserved for my family and people who knew me before the Great Name Change. But I'm kind of getting tired of inhabiting two separate lives so I may just change my name again.

Bodies

Who knew? Bodies change. I thought the biggest change would be that infamous time when I grew breasts and got my period. Pregnancy was fun. I didn't have such a tough time with it, in fact I enjoyed growing babies. Birthing them was tough, but I really loved having little babies and children around, and breastfeeding, and those body changes didn't really bother me. Some fibroids, a touch of hyperthyroid. Nothing serious. 

Menopause was kind of a relief, no more monumentally Niagara Falls cycles. No more fertility, and I was ready for that, because I was happy with my five children. Did I think I'd overdone it? No.

But then, the thing is, everyone goes on about menopause because it's when a woman is no longer fertile and I guess biologically speaking no longer useful. But the body changes more dramatically and more quickly after the whole menopause thing is history.

I've written about this before, and I have to point out, it's not specific ailments that bother me - thank goodness - I'm healthy. But just like during puberty and adolescence, and I'm imagining anyone with body dysmorphia, I just don't feel right in my skin. Its like my clothes don't fit me right, except they do. My clothes fit, I still take the same size more or less, a medium. But it's my skin that doesn't fit. It feels weird, it's too loose, it's floppy, it doesn't feel like its mine. I look funny in the mirror, who's that old lady? Why is her skin all dry? damn it, why didn't I wear sunscreen for all those years? 

So that's the tunnel I can fall down when I don't remember to center and use moisturizer every morning. Yes, it is my body, yes indeed I am very grateful and proud of it, it's like an old car, just keeps on chugging. But I can't help it, it feels weird.

Profession

Oh goodness, could I just say I'm a witch? I guess not....but this is weird too because I think I studied witchery and magic my whole life, and science too of course. And poetry, and of course I learned all about having kids and all when I went ahead and had five of them. 

But my professional label doesn't exist, because I'm not a registered midwife. I'm a birth companion or whatever. My Impostor Syndrome kicks in frequently; sometimes I think my actual profession is "Impostor".

I've mostly been a mother. 

And the renewal part of this whole exploration? It's a deep, deep sense that change means pain, and from pain comes change. Life just doesn't stop, until it does. So, in a sense, my resting, my recovery, my reflections ... lead to a renewal of sorts which is a kind of an acceptance of the continually changing nature of my life: child, young woman, mother, older woman, mother, older woman, grandmother, mother, birth attendant, peace keeper, rebel, anarchist, runner, crone...

Shields, magic, bubbles, screens

 

One of the key qualities that a doula or a midwife seeks to make use of during her journey with a woman as she births is the ability to create shields, bubbles and screens. This quality is akin to magic, and it is hard to access and even harder to use skilfully. 

1. Shields can help prevent a birth attendant from bringing her own baggage to the birth room. To do this, we must place the birthing mother at the very center of the experience, so much so that our own desires, opinions, concerns, and emotional reactions do not really matter. At the same time, we must be constantly aware of the health and well-being of the mother and child, but not in an emotionally infused way. Rather, we have to notice what is happening, much like a Buddhist will notice emotions as they drift past during meditation.

2. Bubbles are wonderfully useful and I made so many of them when I was working as a doula in the hospital setting! A bubble is a protective sphere around the birthing woman. It can include her partner, you as the birth attendant, her midwife, her mother or whomever, but its main purpose is to maintain an emotional or spiritual "space" within which the birthing mother can find her way. Often the woman giving birth has other people's ideas and opinions floating around in her head, which can detract from the intensity of what she needs to do. The bubble will often give her the chance to be fully aware of what her body is doing, so that she can stop thinking through the event.

I will create a bubble by visualizing, but also with physical closeness to the woman (eye to eye contact, light massage), and also with carefully chosen words and a physical distancing (turning my back) from the people outside the bubble. Sometimes it will be necessary for the woman to move to a different room in order to fully accept and embrace the bubble.

3. Screens are effective when there is a danger of you, the birth attendant, becoming emotionally engaged with another person in the birth room. You must erect a mental screen so that your exchange with the other person doesn't infect the atmosphere in the room. For example, if the birth is taking place in a hospital and the nurse is feeling lonely and wants to chat about the patient in the next room, I always like to erect a friendly screen so that the nurse doesn't feel rejected but she knows that conversation isn't appropriate. On the other hand, if a member of the staff is being abusive to the birthing woman I will erect a very strong, impenetrable screen that shields the birthing mother and her family from the anger or ugliness that is taking place. This can be very difficult.

These methods can be used outside of the birth room as well, in stressful situations in all walks of life. Just get your magic on, and you can create a peaceful dwelling for yourself and those around you.

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.

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.

Birth Portals

 Today I am on the second letter ... and that would be B, and B stands for Birth Portals.

This was posted on Instagram by @catearth76 and it is so true! But, and I am so full of "but..." and "wait a minute..." and "sorry what?..." these days, but what about those women who don't use that portal to birth their babies?

No, I'm not talking about how wonderful gentle cesarean is and how it's so great that we can lie on the surgical table and do skin-to-skin. Neither am I talking about women whose babies might have died if they hadn't been intervened with.

I'm talking about women who are pushed, coerced, bullied, lied to, manipulated, scared, threatened into agreeing to surgical birth for their babies when there really wasn't any good medical reason for it. This is a fact, it's real, and it's happening in a hospital near you. Especially now that Covid restrictions have made it impossible for a woman to bring the support she needs into the hospital or birth center, and it's made medical workers much more jumpy and afraid.

What is the actual spiritual damage that is done to that miraculous portal when a baby is yanked out through a surgical cut nowhere near the portal? How can we repair that damage? How can we repair that damage to babies, to women, and to the world? 

This is a question I've been struggling with for decades. I started working as a doula in 1997, and I truly thought that accompanying women to the hospital and providing doula support was a valid option. And, yes, I did have a pretty decently low c-section rate (around 10 %, compared to 25% at the hospitals I attended births at). But watching these births wore me down. Watching intelligent, adult women being lied to and treated like children (actually, since when was it fine to manipulate and bully little children?) hurt my soul.

I quit attending births for a while, for various reasons. And now I've started again, and I'm very clear that I only will accompany women who want to KNOW that they hold a sacred portal between their legs, and they WILL NOT be bullied into messing with it. This is my own bias speaking, partly because I wasn't strong enough to do that - I let every Tom, Dick and Harry and their female counterparts bully their obstetric, know-it-all, fear-mongering way into my obstetric activities. And the reasons behind that are many and unsolvable and complex. But I believe that the way I work now is the way to open up that sacred power, so that women can come back to the recognition of their own selves and their own bodies.

Women contact me at various places in their pregnancy journeys. Since I have been back in the practice, I have spoken with women who want me to walk with them throughout their pregnancies, and others who have called me during pregnancy, during labour, or after giving birth. 

When I walk with a woman through pregnancy, we meet online every week and speak for an hour. Sometimes we could talk about books, or what seeds they're planting. Other times we talk about how the pregnancy is progressing, or where they've decided to give birth, and whom they want around them when they're birthing. We talk about their fears, dreams, desires. We try to plan the kinds of support they will have after the baby is born, and they try to imagine what life will be like when they're responsible for feeding and providing for their new baby.

Sometimes we talk about stuff that's happening in their lives, either in the present or in the past, and how that will affect their birthing. Serious abuse in the past affects how we live in the present, and it can definitely affect our ability to reach deep within to find the power it takes to open that sacred portal. Fighting and anger in the present can sometimes mean that a woman no longer has a home where she can feel safe to give birth in, so that is another hurdle for her to jump over. Physical challenges and illness can also affect our body's ability to give birth, but these are rare. Often women worry too much about the physical aspects of pregnancy and birth, and they don't consider the emotional and spiritual weight of their pregnancy, birth, and parenting.

So, I try to walk with a woman and her family through this important time in their lives while maintaining an open spirit and an open heart. My open heart reflects with theirs and together we can find a place where that shy but powerful portal will open. Women are being cut open for no reason. Placentas are being pulled out with no reason. Women are not listened to when they say they have a pain, for no reason. Women are being ignored when they say they are scared, for no reason.

Or, wait, is there a reason? Who could want to keep that portal scarred and closed? Who could want to stop that power from being unleashed in the world? Who could want a world where we all remembered that we are all birthed through a sacred, fiery, spiritual, creative, awe-inspiring portal? Who might be afraid of a world that was held together by witch power and magic? 

Oh, so I forgot - this is a gratitude note! So I am grateful for Birth Portals. I'm grateful for witches, for womanhood, for love. I'm grateful for the circle of women who surround me and protect me. I'm grateful for the moon and the stars.

Cesarean Awareness Month

It's funny they would have a month for a surgical operation. I have the same feeling about Black History Month. Like, if it's important, shouldn't we learn about black history every day we learn about history? Like, shouldn't the history books be rewritten? They're certainly biased....

I digress. Let's deconstruct history another way:

Pithiviers, France, is remembered by some French Jews as the place where their relatives or friends of the family were sent after the Nazis occupied France. There was an internment camp there where families were separated and the adults were sent to Auschwitz to be killed.

We also remember Pithiviers as the place where Michel Odent was head of the maternity ward from 1962 to 1985. Here, he fashioned his notions of natural birth, by creating an environment where women could give birth in an undisturbed way. He provided singing sessions during the prenatal period, birthing pools, and skin-to-skin contact after birth.

Years ago, I was part of a group of birth workers who brought Dr Odent to Montreal to speak. I remember being so shocked when he suggested that there was a causal relationship between the murder and violent crimes rates in some cities in the world, and the cesarean rates. Effectively, he was suggesting that if you have your baby by cesarean, then they are more likely to become a violent criminal. I immediately took a dislike to him and his silly ideas, and, more importantly, I asked myself why there was a whole room of healthy, young women absolutely worshipping his words? There he was, a shrunken old white guy, talking about how babies needed to go through the vagina and arrogantly proclaiming that women who have cesareans are going down the path to hell, and dragging their newborns along with them.

Fast forward a few years and I was up on the stage. We were doing a little panel about VBACs. A woman stood up from the audience and said that she was newly pregnant with her second, hoping for a vaginal birth after a brutal c-section with her first. She wanted advice from a midwife on the panel. This is what she got: "If you want to give birth vaginally, you have to put your big girl panties on and fight for what you want."

And I remember teaching a class to a group of doula students, and the woman teaching with me said that, generally, women who have repeat cesareans have a lot of unprocessed resentment to deal with, and if they dealt with it their chances of VBAC increases. 

So, in a nutshell, three birth professionals said: women who birth their babies by c-section are driving up the crime rates because their children are more likely to be criminals (also, in an article he wrote in 2008, Odent suggested that cesarean birth may produce more male homosexuals); that women who want a vaginal birth after a previous c-section should somehow grow up so that they can achieve this; and that women who have c-sections may be dealing with repressed feelings, and that repression or other negative feelings such as resentment could be the reason for the surgeries.

If we look at these criticisms from a feminist perspective, they seem very similar to the rape dilemma - don't wear provocative clothing, don't go out at night alone, don't drink, or you will become a victim.

There's a feeling amongst the "natural" birth movement that a woman can have a "natural" birth if she wants it hard enough. We can read of powerful, transcendent, wild, free births where a woman moves through portals to meet her child. These are lovely, indeed, but not everyone can have or would want to have that experience.

In my opinion, giving birth is a very private act. It is so varied, the ways in which we birth, almost as varied as, for example, the shapes of our noses, or the leafiness of our labia. Some women want to birth alone, or just with their partner present. Others want their children there too. Some want a doula or two, and a midwife. Other women prefer a physician, and they want to be in a hospital. Some want to have a midwife follow them, and they want a water birth in the birthing centre.

All of these possibilities should be respected as valid, informed choices. So why are they not? Because, often, if a woman chooses to be followed by a medically trained midwife or a doctor, she ends up giving up her right to informed choice and she gets put on a conveyor belt where she is no longer the central person in this sacred, primal event, and she gets things done to her. The birth process gets put on a schedule; the body is examined time and time again; this or that intervention is done until finally all the options have been exhausted and she is wheeled into the operating room.

Yes, having a doula present will decrease your chances of c-section by a decent percentage, especially if you are a mid- to high-income woman living in an affluent country (https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD003766.pub6/full) 

Women choose to go the hospital to have their babies for many different reasons, and none of these reasons are an excuse for an unwanted and unnecessary c-section. What could these reasons be? 

• they want the security of being in a hospital
• they wanted to have a midwife follow them but couldn't find one
• they don't have health insurance and/or can't afford a midwife
• they don't have a home that is suitable for a home birth (think abuse, living with a lot of other people who aren't supportive, and those kinds of things)
• they don't know their options
• they are forced to because no one will attend them at home because they're carrying twins, or have had several c-sections, or they're obese, or are substance abusers
• they are followed by a midwife but get transferred to the hospital because of government regulations (labour too long, pregnancy too long, suspected this or that)
• covid-related issues reduce their choices

Any number of these women could end up being part of the 25-30% of women who give birth in the hospital who end up with a c-section. The WHO suggests that 15% is a reasonable rate. I insist that here in our affluent country, a c-section rate of 5% would adequately save the lives that have to be saved by obstetric surgery.

How can you avoid an unwanted c-section? Ask questions. Hire a doula, or find one for free. Contact me and I will do my very best to connect you to the people you need. Find a midwife. Get a doctor who hears what you're saying. Say no. Don't do anything that seems wrong. 

Let's work together to put the Cesarean section back where it belongs - in the realm of emergency surgery!

Placenta Magic

"I knew a placenta once. She was a big gal. Knew how to hold her space. I considered inviting her home but others said "oh no - no, no, no.," and then she was gone, just like that."

Most women these days who give birth surrounded by doctors or midwives don't learn anything about the placenta before they give birth, and then afterwards it disappears just like the one Sarah described above. She birthed in the hospital, was followed by midwives, and had no idea that her baby's magical organ would simply disappear into the bowels of the hospital.

The placenta is a unique organ that provides nourishment for the fetus during their time in the womb. It is attached to the mother's body; it works as a filter between the mother's blood and the fetus'; it provides the fetus with oxygen-rich blood from the mother's body, and allows for the transportation of oxygen-depleted blood to leave the fetus' circulation and get transported back to the mother's circulatory system.

After the baby is born, the uterus works to expel the placenta, and if the umbilical cord has not been cut, then the attached placenta separates from the baby's body within a few days to a week after birth. However, it is very common practice now to cut the umbilical cord even before the placenta is born, thus depriving the newborn of some of the oxygen that it could have had access to without the separation.

Many women do not know about the placenta. I've created a Mini Series about this magical organ on my Baby Magic Podcast. Listen up on the 9, 16 and 23 of February, 2021 for a look at the placenta: 

On February 9 we will be guided by Patricia Edmonds, midwife of over 40 years, who will answer the question: What is the placenta? 

On February 16 I will be chatting with two women who decided on Lotus Birth for their babies. One of these women gave birth in a hospital, and the other at home.

And on February 23 two business partners from Australia will enlighten us on placental encapsulation and the benefits of ingesting placenta.

Listen up! I hope our meanderings through the world of women's bodies, justice, and love are pleasing to you. 

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.

The End of Midwifery

A Heavy Heart

My heart is heavy. Guess what guys? The Man won! It's the end of midwifery! Ok, probably not really. There's always movement and change. I guess the brave families who decide to birth at home on their own will engender the new wave of fearless midwives. I hate it when polemics are forced upon you though.

Ok, I will stop speaking in tongues and get to the point.

I can't believe it's been two years since the crackdown. Actually ... yes, two years. In October, 2016, in two Canadian provinces, three women were charged with "practising midwifery without a licence". Also, just under two years that independent midwives in the UK (fully trained and registered as midwives but choosing not to work through the National Health Service) were forced out of work with a legislation that passed in January, 2017 that meant that they needed to find private indemnity insurance in order to take on clients. And in Hungary, professional midwife Agnes Gereb was sentenced to two years in prison for practising midwifery.

Satanic Brain Surgeons?

What does all this mean? Is it similar to a satanic team of brain surgeons who trained at woodworking school and decided to give everyone down-home lobotomies?

Nope. It's a question of what happens with regulations and legislations. It engenders all sorts of divisive tactics and means that the powers that be, i.e. the legislators, have to keep things steady by creating divisions between people.

It was the midwives' associations that took unregistered midwives to court. That same organization was born during the slow process to legalization of midwifery, back when all Canadian midwives were working "illegally": the work itself was deemed illegal. So how could those women have retained their memories of their own actions and still thought it appropriate to condemn others doing the same?

How did The Man win?

Well, it was actually we who lost. We've created an illusory community based on love, trust, love and peace and all that stuff. We talk about safety, honor, respect, inclusivity, but in the end it all disappears in a puff of smoke when push comes to shove. Which it does.

I've travelled the world; created vibrant and useful volunteer organizations (Montreal Birth Companions and WWOOFItalia), and left them; I've been an organic farmer, a midwife, a doula, a teacher. I left that work and now I own and run a small cafe. I'm hiding from the world, I've created a space where at any given time I have a couple of breastfeeding mums sitting n the couch chatting; a lineup of working people getting their lunch; a few retired couples or groups of friends; the constant stream of coffee drinkers working on their laptops. I serve wholesome home made food. I've withdrawn from the birth world, and from the volunteer world, with all of the broken trust and betrayals that both those worlds offer.

What do you mean, betrayals?

I witnessed two NGOs fighting over turf: refugees caught in the middle. Warehouses full of clothing, diapers, and other donated items laying abandoned as not-for-profit enterprises argued over who was to deliver which items where. What levels of insanity are at work here? I was sneaking baby clothes and diapers from the basement of an NGO to take them to a woman in need who wasn't registered with them.

Two volunteer doulas were sexually intimidated, one of them physically, while they were attending the birth of an asylum seeker. Her bible-toting "friend" assaulted one in an elevator and made crude remarks throughout the labor. The response of the aid organization to the complaint? "It's their culture: it's our job to tolerate and teach." What levels of insanity are at work here? Racism: the Nigerian men are all rapists? Sexism: the women's job is to submit and teach by example? Classism: y'all are just volunteers; we are salaried midwives/bureaucrats and our word counts.

I witnessed a 60 year old midwife who was a fully trained professional break down in tears when she read that her government would no longer allow her to practice midwifery. What levels of insanity? Insurance schemes, corporate health care, pitting woman against woman. The end of midwifery.

And on a teensy but frightening personal level, I witnessed a disgruntled doula wreak havoc online by accusing his elders and publicly shaming them.

Culture in Full Decline

We in the affluent world are witnessing a culture in full decline. There are many signs; just look around you. We live in a culture based on fear and suspicion, when there is really very little to fear. The culture abounds with cheap goods made in sweat shops staffed with children who should be in school. The biggest problem of our age is the refugee crisis; xenophobic leaders are being voted in all over the western world because the left has made a caricature of itself. We can buy pot in little plastic child-proof containers; midwifery is tightly regulated; everyone is afraid of each other with no reason; language has been turned inside out. The end of midwifery.

This is where beauty lies.

Real midwives take risks. Real midwives love each other. Real midwives support women. Real midwives can take no for an answer. Real midwives are tolerant. Real midwives know when their skills are not enough. Real midwives are afraid sometimes, but they don't allow their fear to guide them.

For some real midwifery, have a look here, or here. Write to me if you want to know more.

Sending out love on this gibbous moon waning.

Albino Lizards, White Girls and Texas Midwifery

Eight years ago, I decided to go and volunteer in a maternity clinic in El Paso, Texas, right across the Rio Grande from Juarez, Mexico.

Juarez

In 2010, Juarez was no longer the colorful tourist attraction it used to be. Years before then, it was a place people could go for a good time: fun-loving, slightly exotic people, cheap trinkets and good beer. But ten years ago, Juarez was one of the most dangerous places in the world. Drug cartels and common bandits took the law into their own hands and  declared war on almost everyone. Violent crime was booming: murder, disappearances, and shooting sprees were common. A group of young people were shot and killed while watching a soccer game at a birthday party. No wonder Mexican women were coming across the border to have their babies in the relative peace of a maternity clinic in El Paso, Texas.

Midwives for Mexicans

It was a win-win deal: the babies got U.S. citizenship, affluent do-gooders like myself could gain experience, the mother got good midwifery care for a rock-bottom price, and the Texas gun laws, though lurid in the eyes of most Canadians, meant that the chance of getting shot in a gangland drive-by are lower than across the border. One woman had to decide whether to come across for her baby’s postpartum visit or to go to her husband’s funeral. He was shot the day she came up to have her baby. She decided to come for the postpartum. She said her husband had been an innocent bystander, but who knows. The original reason for the violence may have been drugs, but no one knows why the killing happened.

Getting There

My flight from Montreal to El Paso went through Chicago O’Hare, a bland, sprawling, badly laid-out airport. O’Hare was clean and bustling early in the morning. I especially liked the automatic saran-wrap toilet seat covers. Lo-fat triple choco smoothies were on sale at the breakfast counter. On the small propeller plane, the cowboy with a handlebar moustache got a seat next to a tourist lady, who politely engaged him in conversation. There was so much wax on his moustache you could have lit it on fire and it would have burned like a five-hour candle.

From my window on the plane I saw the city sitting at the edge of a straggly desert, surrounded by mountains; barren, rocky, and magnificent. I ventured out into the heat and felt like dancing. The sun cleared up all the Montreal autumn from my bones. The Mexican taxi driver was enthusiastic about Canada, and suggested it was a good place to live.

El Paso

On the drive in from the airport, El Paso appears to be full of tawdry car dealerships, McDonald's, Whataburgers, and dollar stores. Most houses are either for rent or for sale, except the large mansions up on the ridge overlooking the town. Downtown looks like Calgary, circa 1961. But the mountains surrounding the town, the blue skies, and the dry heat make up for all the eyesores, and white trash sleazy becomes genteel Southern decay. The Mexican influence is everywhere: from the numerous Taco shops to the sounds on the street, the faces passing by, and the friendliness that is not the usual sedated grizzly-bear feel of small-town American camaraderie but more a reserved and genuine cordiality. It is still America, and to a homegrown Canadian everything seems grotesquely super-sized. I went into a health food store the size of a Wal-Mart. How can I choose between forty-five different types of organic underarm deodorant?

Midwives are weird

The maternity clinic in El Paso was a few blocks from the border, on the service road of a busy highway, across from the rail yards. At any time of day or night, you could hear women moaning in labor, trains whistling, motorbikes racing, newborns squealing, and frazzled midwives yelling instructions to bemused interns. There was a brief time around three-thirty in the morning when there was a pause in the traffic, and the trains take a break, but by four o’clock everything was up and running again.

Midwives are strange creatures and tend to live inside. The place was dark and closed and mostly illuminated by electric lights. Going out to take the trash into the alley was wonderful. The air smelled hot. The bright sun hit the ground and my skin with a jolt which soon wore off as I walked back into the air-conditioned clinic.

Halloween

I’d been on shift since the early morning and I had twelve more hours to go until I had a day off. My day off would fall on the Day of the Dead, which I knew from Italy as a national holiday, a day of celebration and a day the living visit the cemetery and the dead visit the living. By six in the evening I was exhausted but exhilarated. I loved working with pregnant women and newborns. The clinic was empty now, the office staff had gone home and the place was quiet and slightly spooky. The secretary had been wearing skull earrings and there was an air of ill ease in the place. It is an entry point for some into the U.S.; for some it is the door between life and death, and for others that door never opens. We know that so we are always prepared. Whenever you are waiting for a birth, you are always waiting for the unexpected.

Birth

At nine pm the doorbell rang and we went to answer it. There was a black Silverado in the drive. A small woman stood on the steps supporting a larger woman who was obviously in labor. Her aunt carried the bags even though she was crippled from a childhood struggle with polio. Her body was shriveled, but she had obviously learned to use it – it wasn’t her niece who had driven the truck. An inner force twisted her body, and the process had distilled the joy that we usually store deep inside and brought it to the surface. Her face shone. Her eyes were black and she spoke with authority. I helped the woman to the bathroom and then we made a slow procession to the birthing room. The primary midwife was bustling and fussing with equipment. I focused on the birthing woman, who was speaking Spanish to her aunt, who translated to me. “She’s having the baby now!” That was clearly true. As we removed her pants, I lifted the baby and laid it on the woman’s chest. The baby was tiny and silvery, with a small tuft of black hair and perfect features.

By midnight it was time for them to leave. The aunt shouldered all the bags and told me she would need help with the baby’s car seat. She hobbled outside and packed up the truck. The new mother strapped the little girl into the car seat and I picked it up and carried it to the truck. The seat belt didn’t work properly but it didn’t matter; the aunt told me to stop fussing. They needed to drive for a couple of hours before they would be home. The baby would be fine.

Escape from Midwifery Boot Camp!

I cleaned up and soon enough no one would ever know that a baby had been born in the room just a few hours ago. Everything was clean and bright, waiting for the next one. I slept a little in the chair and by the morning I was ready to take a break. Within a couple of hours I found myself in a rented PT Cruiser driving down the highway on my way to the desert. I followed the road signs to White Sands, past the mountains, until the land was flat and bare and the vegetation was short and prickly. Tumbleweed rolled by and I couldn’t decide whether I was on the set of a spaghetti western or Road Runner. I kept the windows open and tried to find some music on the radio. All I could get was Vivaldi which didn’t fit the mood so I muted it and concentrated on the road.

But not well enough.

The road got narrower. What few vehicles there were seemed to be going very fast. I passed some road kill that looked foxy, and I realized the place was infested with coyotes. I passed a sign that looked vaguely military, but I didn’t take much notice. The asphalt ended and I saw a dusty sign in Arabic. Then a large dust cloud rose in the valley and I saw helicopters hovering above the car; I had stumbled into a military area, so I carefully turned and went back the way I had come.

Desert Bound

I was almost back in El Paso when I saw the sign to White Sands National Memorial, so I headed out and found myself back in the desert. Blue mountains rose in the distance. The land stretched for miles, hot and dry. The road ahead shone with the heat. The sky was crackling, the road was straight and I was hungry so I ate a banana and threw the peel onto the shiny road. I prayed for a gas station and I wondered what I would do if I ran out. I turned on the Vivaldi after all, and then found some Mexican love songs.

Finally in the distance I saw what looked like civilization, or something like it. As I rolled into town I saw a sign towering above the shacks that said “Outpost”. Beneath it were three fifties-style gas pumps. Behind the gas pumps there was a small table and two chairs. The chairs were occupied by two skinny men with raggedy grey hair and a few teeth. Of course they were in their fifties, like me. They were very friendly and one of them had a relative in Ontario. They assured me that White Sands was the place to see, “It’s one of the Seven Wonders of the World”. It would take me another hour or so. I filled the tank with gas and got back on the road.

The blue mountains got closer and became a wall of grey stone in the distance. I couldn’t see any white sand and I was wondering if this was all in vain. The desert started to change and the land became flatter. I followed a signpost and arrived at the adobe visitor center where tourists can fill up on trinkets and rent sleds to slide on the sands. I took the dune road into the sands and wasn’t impressed. I’ve seen dunes – on the Mediterranean, on the coast of the St Lawrence Seaway, in the Sinai, in the Sahara. Hah! White sand, scrubby bushes, dunes…

Albino Lizard

I turned a corner and suddenly I was in the mountains going skiing. The hills rose on either side of the road, white. The road was white. I stopped the car and climbed up the hill. At the top I looked around – hills and hills of snow, as far as I could see, all the way to the blue mountains that were back in the distance. I looked down at the sand. It was fine like baking powder and stuck to my legs. I sat down and wrote some words in the sand. The heat was dry and delicious. The sand was soft. I saw movement in the corner of my eye and I froze, thinking of snakes. A small bleached lizard walked in front of me, turned around, and stared at me with his little black eyes. His paws rested on the white sand in front of him and he blended in perfectly. He reminded me of the little silvery newborn I had seen a few hours before, in his place, gazing at me.

C and W

Hunger drew me back to the car and I started back, eating an apple and wishing I could stay. I drove away from the dunes and back onto the highway. The mountains seemed closer in the setting sun and I found some country music on the radio, singing about 9/11, patriotism, God, guns, and girls. I rolled down the windows and turned the music loud. Pickups were a theme on the road and on the radio. When I got back to town I got a ride to the clinic from the car rental agent. He told me about his fiancée. He takes her on a trip to a different place every year. Last year they went to Vancouver – it was too cold, for desert rats. Maybe Montreal next summer, he had heard it was a party town.

I went into the clinic. Two women were in labor. They would give birth during the night and drive back to Juarez in the morning. Later that morning, the woman I had assisted would come back to the clinic with her sister. The aunt didn’t come. I unwrapped the baby and she lay, perfect and silvery, her black eyes staring at me from a desert-like place.

Postpartum Intensive November, 2016

We are offering a postpartum doula training for people who want to work outside the box. This course will give the student an in-depth understanding of the period from birth to eight weeks postpartum. The physical, emotional and psychological experience of the postpartum period will be discussed and challenges during this time will be examined. Alternative methods of maintaining postpartum health will be explored.

The course runs from November 18, 19, 20, 2016 and the cost will be $350; $300 earlybird special (register before September 18, 2016).

What will be covered? Day One: The normal mother baby after birth from birth to eight weeks postpartum: mother care, baby care, feeding, emotional health, family, and more. Day Two: Challenges during the postpartum period: what to do? When to refer? Day Three: Role play, discussions and case studies. The workshop lasts three days and will continue with mentorship and support afterwards.

Meet our teacher:, Erin Ryan CPM

"I began working professionally as a midwife in 2000, In that time I have attended over 900 births, working throughout the US as well as rural clinics in Bali.  In my 2 years in Bali I worked in a clinic as well as doing home births and I served women from over 15 countries.  I’ve seen babies born in many different environments, and I have worked with women and families from many different cultures from all corners of the globe.  In all circumstances, the constant has been loving care and respect for the mothers I work with.

My fascination with birth started at a young age.  A Laura Wilder fan, I was curious about how pioneer women delivered their babies on the frontier.  Life led me from Little House on the Prairie to the University of California at Berkeley.  After graduating, I immediately began pursuing midwifery, working as a volunteer doula at the county hospital, and later attending and graduating from the National Midwifery Institute.   While gaining a strong academic foundation, I trained as all good midwives traditionally have, through apprenticeship with some of the best.  My education did not end there; I continue to learn through research, consulting with midwives and other medical professionals and most importantly from the wisdom of mothers.  I pass this knowledge along to my colleagues and clients to continue improving birth experiences for women everywhere."

Interested? email us at mbcdoulaschool@gmail(dot)com

Burnout

Mama and son in Barbados

 Mama was happy.

This story is about burnout. About that feeling you have when you have so many worries and brightly colored post-its stuck inside your head that you mainly just walk around your house looking at things.

My particular form of burnout started in December, when my mother came to visit with a large parasite on her neck. Cancer is weird that way. This thing just grew and grew and grew until it just sucked her away.

I made her a party for New Year's:

L'Chaim!

Then I got back to work. In January, I organized a big doula workshop with my friend Debra Pascali-Bonaro. It was wonderful, all things doula, all the doula students ... the hotel was crap, I learned my lesson about cheap hotels. The food was great - having a chef for a son is a bonus (yes, I paid him). 

I also attended five births that month. I realized during some of those experiences that I had to stop attending hospital births for a while. I couldn't bear to see unnecessary things done to women by people who had not bothered to educate themselves about the birth process. 

I studied like crazy for my CPM written exam. When my second son (the boy in the picture!) was born 28 years ago, I realized I wanted to become a midwife. Not because I had a wonderful birth experience but because in fact I was horrified by the approach and the touch of my birth attendants, and I was drawn to treating women with love.

I wrote my exam, and I passed!!! Now I am a Certified Professional Midwife. 

Then the parasite on my mother's neck took over my life, from February until March when she finally passed away, I was caring for her, sometimes from a distance, sometimes right by her side.

Home death isn't all its cracked up to be. Death can be pretty awful, really. I've seen death and its never so nice, but my mother's death was hard. 

And so to mourning and grief. In the Jewish faith, you just sit for a week and don't do anything. This is good. Then for another three weeks your activities are limited. This is also good. 

I have taken good care of myself over the past month. I realized that some of my big disappointments over the past few months are really little - the rejection slips piled up, so? So I started running again, back up to 4 k, and working on it. I want to get to ten by the end of the summer. I eat well. I try to do fun things. I cherish my kids and my family. 

What is the cure for burnout? Be gentle on yourself! This means being able to walk around the house and look at things. To stand in the middle of a room and think for a few minutes. To have a piece of chocolate. 

It also means saying no when you need to. Not always, but when you need to. It means making sure you have a couple of friends you can call when the going gets tough. It means not taking yourself too seriously. It means pushing yourself to get some exercise. It means starting slowly to get yourself back at work and play, but starting! Start off slowly if you need to, but you will need to. Burn-out can't last for too long, because then it becomes chronic tiredness and pain or illness. Treat yourself like a pussy cat for as long as you can, but when its time to get moving again, you will know it.

This particular pussy cat is so happy to be back from the edge! My energy is solid and growing. I am back in the birthing room, after some time away. I have my patience back. I am looking forward to an active and productive year, as the MBC Doula School blooms and MBC continues to provide service for those who are in need. 

Thank you for traveling with me for these past difficult months - the list is long, you know who you are. 

Ibu Robin Lim in Montreal

Midwife or Doctor?

Watch this video of Ibu Robin Lim giving birth with a doctor in attendance, then with a midwife!

Levatrice....With Woman

Six weeks after I gave birth to the second of my five sons, I was driving our ancient old station wagon back home from dropping off my father-in-law at the airport in Pisa. I was happy. We were heading home to our place in the hills above Florence, where we lived in an old stone farmhouse. My husband taught English and was mostly gone in the evenings. I took care of the little ones and tried to speak Italian.

I remember where we were on the road. I suddenly realized, and I turned to my husband, and said: "I want to be a midwife".

I volunteered with St. John's Ambulance when I was thirteen. I learned everything a young girl could about first aid, and I competed in contests, fake blood and all. I volunteered every Sunday at the Grace Hospital - maternity care, 70's style. The moms were in wards, the babies were behind glass, and the dads could watch them from the hallway. My duty was to take each dad to his proper mom, and to distribute evening snack: apple juice and tea biscuits. I loved it: I loved the new babies, the new mommies, the warm, tea biscuity smell of babies, poop, and women's bodies.

I had a butcher-shop experience at that child's birth: unable to understand the language, I turned to victim mode and suffered uncaring doctors, making jokes over my body; a midwife smoking cigarettes; general anaesthetic, and a baby I didn't even see for over 24 hours.

Midwifery seemed like a good idea.

By 1988, I had enrolled in the Apprentice Academics program. This was distance learning, the good old fashioned way. I read the texts, wrote the assignments, followed my guide, and we sent envelopes and packages back and forth acroos the Atlantic.

By 1991, we had four boys and our small mixed organic farm (complete with large stone house to rebuild - just the two of us....with a little help from our Wwoofers - but that's another story); a large garden, chickens, ducks, geese, a vineyard...life was good! But I still dreamed of midwifery and studied my textbooks at night, collected my Birth Gazettes every month from the postman. I wrote a couple of articles....kept in touch with the lovely women at the Farm.

In 1997 life changed and we ended up in Montreal. I was working as a doula and witnessed many births over the years. These were hospital births.

I am a levatrice - this is the antique Italian word for midwife. I don't use the words "midwife" or "sage-femme", because if I did, I could be accused of practising medicine without a license. But I don't practice medicine. I attend women in childbirth.

I am in the final lap of a years-long process that will end with two exams. When I pass them, I will be able to put the letters "CPM" after my name. Certified Professional Midwife. (Update - I passed my skills exam - only my written to go!)

I teach many young women about how to care for a woman when she is giving birth. These women ask me about the best path to midwifery. There is no best path. My path has been long and interesting, and I am blessed to be able to say that I do what I love.

But at the same time, I am nervous every time I go to a woman's birth. I am excited, and honored, and a little afraid, to be taking part in such a powerful event. And so, I am nervous about my exams. I want to pass, but a little voice inside says that maybe I'm not learned enough.

So, this is the card that was shown to me:

Three of Wands (R) - Learn to be receptive to your needs for a new direction - recognize when your talents, skills and efforts are being wasted. There will be resolution after some struggle - but, much work is still needed. The proper balance has not been obtained because you are preoccupied with your "inner" thoughts to the exclusion of outer advantages. You are actually looking away from the power that is available to you. You have become too giving and this allows others to take advantage of you. You need to check everything before moving ahead. A careless approach can ruin everything. You may experience the failure of some project due to "storms" or problems that are greater than you had anticipated.
You are trying to become involved with the environment after a lengthy time of detachment and reflection which has been disturbed by negative memories. You must be alert to the new opportunities that present themselves and use them wisely. Remain open and receptive to new business ventures and partnerships with reputable people. Be willing to operate from a place of integrity as you move forward - assured in your mind that your heart, mind and spirit are in balance and you are clear on how you wish to handle upcoming situations and the important choices you will be making.
There can be flaws that interfere, keeping dramatic progress on the path just out of reach. The desired qualities for this stage may be present in abundance, but for some reason, the project at hand is off target. Check, possibly right project, wrong motivation or right motivation, wrong project. Guard against over optimism and spiritual vanity as you would against pessimism. Guard against complacency as you would against a nomadic restlessness forever more and more.

I would like to send gratitude to everyone who has accompanied me along this path - and also to invite everyone to a huge party when I finally get that CPM. Maybe that's what it's all for....

Birth Abuse

Birth Abuse. This is a commonly heard term these days in birth circles. What exactly does it mean?

Is it abuse when a woman wants to have a home birth but can't find a midwife because of government regulations, so she ends up compromising on one of the most important decisions in her life, and having her baby in a hospital, lying on her back?

Is it abuse when a woman from another country comes to the hospital in active labor and is spoken to very loudly as if she is a slow-witted child?

Is it abuse when a woman wants to give birth squatting, after a two hour labor, but the doctor insists she lay down, and after the head is born, a shoulder dystocia develops and the doctor pulls so hard on the baby's head that he breaks her collarbone?

Is it abuse when a resident has his hand in a woman's vagina, reaches for the amnihook, and before anyone can say "boo", he breaks her waters?

Is it abuse when a midwife insists that a woman lift her shirt so that she "feels more relaxed" as her baby is being born?

Is it abuse when a doula pushes a woman just a little bit too hard to avoid taking an epidural, and afterwards the woman feels she has been traumatized by the pain?

Is it abuse when a woman is pushing and the doctor stands between her legs and yells at her, demanding to be paid in cash?

Is it abuse when a doctor speaks in a sexual way to a woman who is ecstatic, just after giving birth?

I have witnessed all of these situations, and I believe they all are examples of birth abuse. Yes, some are more shocking than others. Some are definitely in the grey area. But, essentially, abuse in the birth world takes place when there is an absence of respect. Respect is paramount when a baby is being born. The woman who is doing the work of bringing a new life into the world is more deserving of respect than anyone else. But, strangely, in our world, this has been turned on its head. The birthing woman is under everyone else's thumbs, saying "yes" and being a good girl, and agreeing to other people's agendas and priorities.

Is it abuse when a woman goes to the hospital after laboring at home for many hours, and a collective decision is made that this baby needs to be born surgically? NO.

A simple procedure, or surgery, or an interventive test, do not constitute abuse. Abuse takes place when anything is done to a woman against her wishes, or without her agreement. Simple.

Birth abuse is big. Everyone who works with birthing women - doctor, nurse, midwife, doula, anyone - should take a few minutes out of each working day and have a close look at the way they have treated their clients, and if they feel they have not treated the birthing women in their care with the UTMOST respect, then they should make changes.

Birth can be powerful, it can be joyful, it can be frightening and terrible. Birthing women need to be at the centre of everyone's vision so that we can recover an essential balance that we have lost. When women are at the centre of the birthing world, who knows what miracles we will encounter?