Raise Love Consciousness with Maha Al Musa

When I asked Maha to give me one word to share her message with the world, she gave me three. Raise Love Consciousness.

I was thrilled to have a couple of hours chatting with Maha about childbirth, consciousness, sovereignty, feminism, bellydancing and her work liberating childbirth, women and babies.

You can reach her on Instagram, Facebook, or check out her website. 

Are you pregnant and looking for a guide to uncover your inner power? Are you a Birth Keeper who wants to learn more? Maha's unique birth preparation program is for pregnant mums who innately know that giving birth is meant to be a sacred, instinctual and an embodied experience and who are seeking an immersive and expansive experience as they flow through their 9 month journey. It is also for birth keepers wanting to reframe birth's purpose, be inspired by a view of birth that will raise human consciousness and understanding the journey from a sacred, wise lens to share with mums-to-be.

I am so honored to have the chance to speak with powerful BirthKeepers, Educators, Mothers, Artiists, Rebels ... Baby Magic is magical!

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.

Being Black, Being White

L'expérience de grossesse et d'accouchement des femmes noires, qu'en est-il au Québec?

We had a typical Quebec moment when the organizer of this important forum invited me to speak, as a white doula who has had many years of experience serving black families, and I had to decline because of my own religious practice. I really love this aspect of living here, in Montreal, in Quebec, in Canada, where cultures, religions and heritages slip and slide together, usually quite happily.

Instead, I compromised by offering to write a small piece about my experience as a white doula and midwife here, and the advice I would give others when working in the black community.

First of all, let's get something really crystal clear here. Yes, there are different variegated levels of privilege. But if you are white, you pretty much have to accept that come what may, you are more privileged overall than any person of color. I will never, ever understand the nature of the every day racism that my friend Elizabeth experiences. Yes, she has a great life, yes she owns a beautiful apartment and makes good money and yadda yadda. But people look at her and think something that has to do with the fact that she is black (beautiful mama, african lady, exotic queen, and so on),  and they don't do that with me, or at least if they do decide to put me in a box, its not based on the color of my skin.

So, now that we've got that out of the way, let's talk about how our experiences as white people affect the ways that we work with or for the black families we may serve.

We can fall in to one of several potholes on the road to true justice and tolerance:

1. Overcompensation. Please don't make the mistake of thinking that you need to somehow "fit in" to your clients' cultural or religious activities, beliefs or customs. It's just dumb. You are YOU. Be gracious, be humble, be authentic. Don't wear particular clothes, talk in a certain way or act differently just because you are working with people who are not like you. You will never know what its like to live their experience, so just plan on being respectful and courteous, and try not to pry.

2. Cultural Voyeurism. It's true, some African or Caribbean cultures seem so cool and attractive to those of us who grew up in, Calgary, for example. However, it is not your place, as a guest in someone's home, and particularly as a guest in someone's life, and at a very intimate and powerful moment of that life, to explore your fantasies about what their cultural heritage might be. You are not in their lives to learn about their culture. You are particularly and specifically there to accompany that family on the path to parenthood. The tasks that involves are pretty much the same across the board. Provide prenatal education; facilitate informed choice; translate and interpret medicalese when necessary; assist the parent(s) to figure out what they want for their birth experience and how they plan to reach their goals. Love the new family. Create kind and lasting relationships within the maternity care team. You're not there to find out what its like to be from Congo, or from Switzerland.

3. Random Assumptions. These are the beasties that really get to me. Just keep your assumptions to yourself and everyone will be better off. Remember, something you may characterize as a harmless opinion could be a hurtful assumption.

4. Trauma Rating. Please don't go in to a relationship where you (white person) are providing care for a (black) person, where you have any intention of "turning the racism tables". It doesn't work that way. Historically, men have oppressed women and white people have colonized colored people. It's history. Let's try to avoid playing a game of who has the worst history. That never ends well. As a white person who has been involved in non-profit work for many years, often providing pro bono services for black and other colored people, I see clearly the pitfalls of the Great White Hope and I see how tempting it might be to share my awful traumas ("just like yours, see?") with others. But its a mistaken path. Your pain as a nation or as a people is different from mine. All I can do is respect, love and do my job.

Finally, because this forum is about the black person's experience in maternity care in Quebec, how do these points above affect the doula, midwife and birthing person? Institutionalized racism is a reality in our hospitals today. ("Mexicans bleed, West Africans scream, East Asians' babies don't descend, North Africans come to Canada to cheat the health care system" etc etc etc). As a black person receiving service from the maternity care team, it is so important that you have a birth companion with you who can accompany you through a hospital stay that may be less than pleasant. As a white doula or midwife, watch your words, be doubly careful of acting out your own prejudices and generalizations. Watch your tongue! Open your heart! Stay human!

March Gratitude the Fifth Day

I am grateful for many things the begin with "e": elephants, eggs, eggplants, endings, energy, and so on. But today I am particularly grateful for Egypt.

In a metaphorical sense, Egypt was always the place of slavery that the chosen people escaped from. I feel very uncomfortable with the concept of "chosen people" so I don't really like to think that one through much. But I do like the idea of moving away from a place of slavery. And I love the story of the midwives who continued to accompany mothers through birth, and chose not to follow the law that required them to kill the male babies.

But in my own story, Egypt was a wonderful place. We landed up in Cairo after a rather disastrous "meet the family" episode in Israel. I realized that I might be forever entwined with a narcissist, but I didn't realize it consciously so I tried to be polite. Cairo was full, smoky, sweaty, smelly. It was lovely. It evoked everything. We were only there on our way south, but Sudan was proving difficult to go to, so we stayed in Egypt for six weeks while we waited for visas. We stayed in Cairo for a while, in an awful decrepit "guest house".  Poets, drug addicts and travellers hung out there, waiting for the next adventure.

We went to see the pyramids. Some women gave us fresh pita they'd cooked on the walls of their bread oven. Then we went into the Sahara. I remember at a truck stop, we sat on a bench and waited while the men prayed. The call to prayer was coming from a little transistor radio. A dog was chained to a tree. The sun was light blue.

We were dropped off at an intersection by a gravel pit. The truck left as the sun was setting. The old man who guarded the two huts gave my husband a big rock to put on the inside of our door, in case he tried to come in during the middle of the night after me.

We made some friends in Assiut, where we had to go because I had caught a terrible desert cold. We spent every day together, from early in the morning until very late at night.

I am grateful for the fact that I have those memories of travelling the world, together with my love, and that I can remember Egypt and the desert and the prayers and the minarets and the hash and the sun and the cold and the striped cucumbers and the sweet oranges.

Losing Your Self

Back in the fall, I went to a birth. It was the first birth I'd been to in a long time. It was wonderful! But it was very different from how I imagined it would be.

I always love the feeling that I am doing exactly what I was meant to do: accompany women during childbirth. The most important lesson about birth is that it is very much like life: you can't really plan for it. Meconium happens. Stuff gets broken. People get lost. Suddenly you turn a corner and there is the most beautiful sunset you've ever seen.

Here is a picture of an obstetrician waiting for an unsuspecting pregnant woman. She is being pulled along to the birthing room by her husband...dropping her slipper like Cinderella...he is rushing to punch the clock ... I'm late! I'm late!

The doctor holds a limp pair of forceps in his hand. He is going to get this baby out, for once and for all!!!

Of course, birth doesn't usually happen according to our plans, or according to anyone's schedule or hourly rate. Babies come when they want, or when they need to leave their mother's womb, or when the womb needs to expel them. Who knows. But they don't generally show up when we plan for them to.

And then when they do, the birth unfolds in a different way from what people had been expecting or planning. Which is why I still don't believe that birth plans are useful. Not because birth shouldn't be thought about and considered deeply, that choices shouldn't be made about where you want to give birth and with which people around you. But because the unfolding of your birth experience, of any birth experience, is unpredictable and can't - shouldn't - be pinned down. Because if you try to capture it with a plan, you could miss out on something extraordinary that you hadn't thought about, that couldn't be contained by your plan.

So, what does that mean for us attendants? How do we plan our days and our lives? 

Birth attendants are often on call day and night. Doulas may be on call for months at a time, unless they structure their work effectively by creating a doula collective which involves sharing care. But most doula clients want the continuity of care that means that one doula is always available. So there go your plans for family events, sleep, trips....

But in a deeper sense, when you are actually attending a birth, when the labouring woman is there deeply in the process of birth, then what? Are you thinking about what groceries you are going to buy tomorrow? No, you are with the labouring woman. You are providing support for her and her family, her partner, whomever. Even if you are sitting in a comfy chair knitting: your intention, your senses, your compassion, your heart and all of your focus are bound up with the birth process and the safe place you are creating for the newborn family to move through.

And then you lose yourself. You forget about your worries, strengths, failures, envies, moods. Your only task is to serve birth. You are serving the woman as she moves through her experience of birth, as she becomes a mother. And are you the most important person in the room? Is the obstetrician the buck upon which stuff stops? Of course not. The most important people in the birth room are: the mother and the baby. And how they are treated by everyone else is the most important aspect of the whole process. So, the less we all worry about ourselves, and the more we focus, truly focus, upon the family-to-be, the better off everyone will be in the end. Losing yourself is just the beginning!

Law Abiding Midwives

We humans have a tradition of honoring the midwife, one way or another, or at least we have ways to remember her and tell our children about her. Whether she is La Befana, who comes on the night of January 5th to deliver gifts to Italian children, or a kindly grandma, we remember her and she is always at the back of our consciousness, for better or for worse.

In the Jewish tradition, we tell the story of the two midwives Shifra and Puah, who worked illegally to continue to assist women giving birth, during the time of the oppression of the Jewish people in Egypt. They refused to obey the Pharoah's command, which was to kill the boy babies. When Pharoah questioned them, they gave him an answer that he couldn't refute, that the women delivered so quickly they couldn't catch the boys to kill them.

That sounds like an illegal midwife's story: when she has to transport a client to the hospital, she lies and says she was "just" the doula, and that the baby came so quickly that she didn't know what to do.

Midwives have been feared. We've been targeted, killed, oppressed, abused... we have been painted as the old lady with large warts who rides a broomstick and eats toads. We were burned as heretics and witches during various periods of human history. We've got magic in our hands, that's certain: we know about birth, life and death ... we know how to comfort a woman who seems like she's dying, and we can heal a child with herbs and loving care. 

In one obscure tradition from the Book of Enoch, some angels were looking down and they fell in love with human women. They got together and fell to earth, had sex with the women and exchanged with them the knowledge of fire, herbal healing, and magic. 

And all the others together with them took unto themselves wives, and each chose for himself one, and they began to go in unto them and to defile themselves with them, and they taught them charms and enchantments, and the cutting of roots, and made them acquainted with plants. And they became pregnant, and they bare great giants.

coltsfoot

Midwives have a great tradition of teaching through apprenticeship. We believe that book learning is a wonderful thing, indeed, the knowledge we have instantly at our fingertips is truly marvellous. The scientific method is an absolutely necessary tool that midwives need to know how to use. But there is nothing to compare to the knowledge that an apprentice gains by witnessing her mentor at work. She learns by watching, listening, using all her senses and intuitions to understand and absorb the skill and art of midwifery.


Midwives accompany women on their birth journey, knowing that it is not always orgasmic and fun. We know how to spot a small dark cloud on the horizon, and when to intervene, and when to send a woman to the hospital, if such a thing exists where we are practising. I recently heard a commentary on natural birth: "Fuck! This is horrible!". She birthed about a half hour later. The pain was immense, no drugs were given, she thought she was going to die, and didn't believe us when we told her otherwise. She birthed, and will always remember how strong she was.

Midwifery is now taught in universities in much of the western world. Graduate midwives then are licensed and controlled by state rules and establishment guidelines. These guidelines are not midwifery guidelines, necessarily. Some of them are in place to help midwives save lives, but others are not. Midwives are put in a difficult position of having to make decisions that go against their knowledge, intuition and skills so that they are not penalized or ostracized by their peers.

I have followed a crooked, witchy path to midwifery, that included being taught by many, many wise women and a few wise men.

Here is a Solstice shout out to the original illegal midwives, Shifra and Puah, and to all the women I know who are practising honest midwifery in the here and now.... you know who you are!

Home Birth and Home Death

Babies sometimes just pop earthside but mostly birthing women want to have some company when they are going through this earth-shaking, phenomenally life-changing event.

I was born with a natural talent to accompany women through their birth journeys. I don't even know what I do most of the time but women tell me they feel better when I am present and quietly witnessing their changes. I tell them that everything is fine. I comfort. I nourish. It's just part of me, hey? I am not writing this because I am clapping my own hand.

When a person sees the woman they love looking like she's probably going to die, because her eyes have gone all weird and she's kind of fainting, they feel better when I tell them that this is normal, she is tripping in a special, life-giving way.

And it is truly magical if this event can take place at home. At home, a woman can run through her whole labor process in her own space. She can barf in her own garbage can. She can make love with her partner in her own living room. She can crawl backwards to the fridge to get apple juice.

She can give birth herself, surrounded by people who love her. She can cuddle with her new child in her own room, and she doesn't need a car seat.

I had a friend back in my hippie organic farming days: she had a c-section for her first child because she was breech, so she had her second on her own. She sent her husband and daughter off for a long walk (!), made sure she had enough methergine from the goat's birth kit, and birthed alone. She told me it was frightening. She would have wanted to have a midwife present, and so the third time around, she invited a midwife along for the ride.

Some women freebirth. These are women who birth on their own or with their partner and children. They trust the birth process implicitly and do not believe they need a midwife. Many women who wish to give birth at home do want a midwife, and midwives are generally respectful of the birth process and knowledgeable about serious challenges, even life-threatening ones, that very rarely unfold during birth.

Right now, in Canada, there is an ongoing discussion about end-of-life care. Many people are suggesting that death moves back home. This sounds all warm and fuzzy but let's look at the reality of this phenomenon.

First of all, I wonder why we are not talking more about bringing birth home? Is the dollar playing a part in this discussion? Possibly. It takes a couple of days, max, to have a baby. Midwifery is an economically viable option if you look at the bigger picture of health care in our country. The women giving birth in our country are, in the huge majority of cases, healthy and well-nourished. Group prenatal classes are popular and prenatal visits are easy to schedule.
Even when birthing women give birth in the hospital, where physicians can make their salaries and the women's hospital stay is almost always less than four days, birth costs less than death.

Dying takes a lot longer. Palliative care can be offloaded to families, private nurses, volunteer organizations and the occasional medical professional for the weeks or months before the final days.

Birth at home is a joy, a beginning, it is a moment that is too short to comprehend, passing in the blink of an eye.

Death at home can take weeks, even months. The family can implode, or explode. Money becomes scarce, life can enter a fog. When the final days come, they can be full of body fluids that no one wanted to deal with, disturbing images that no one can forget, emotional moments better left unspoken. I wonder why people think that birth is "too messy", and they romantically envision themselves dying peacefully surrounded by their loved ones? Have we so lost touch with reality that we think that dying in bed is like in a TV show, where the patient just slips away in the arms of her loyal husband? And the nurses stand around the bed with tears in their eyes?

Death can be just as messy as birth, and often is. I have attended many "clean" births, where the baby is born to a minimum of amniotic fluid, blood, poop, and vernix. But some births are bloody. Some births are full of waters. Some are so astoundingly shit-filled you wonder if it was intended divine humor. Some births have a little bit of everything: vomit, stool, meconium, urine, amniotic fluid, blood ...

People I have spoken to who felt that their relative's home death was a good experience were people who could afford to have a private care giver who was discreetly present for the family, or they were well acquainted with the body and its many processes. Others felt that the family was ill-equipped to deal with the physical death of their relative, as they were going through difficult emotional issues, perhaps complicated ones, and the physical realities were hard-hitting.

I thought I was well equipped to accompany my mother through her dying hours. I had nursed my father for the months he was bed-ridden, and I feel confident in my relationship with bodies.

I was wrong. The constant pain was so difficult for me to bear. I was voted as the family member best equipped to administer morphine. I didn't know if it was the right thing to do, even though I did it every two hours for a couple of days. I was the one who changed the pads. So much liquid! Who knew that the body basically dissolves at death. It wasn't urine. It wasn't amniotic fluid. It was vital fluid, leaking and leaking. Every time I changed the pad it was like torture, for me and for her. I was the one who tried everything to counter the pain of oral thrush. Did you know that this is a sign of the end of life? I have assisted many mothers through the intensity of vaginal, breast, and newborn thrush but this was above, beyond and off the charts pain for the woman who gave birth to me. She couldn't eat. She couldn't drink. All she wanted was a big tall glass of water. She was listening to the poetry in her head. She said that there were raucous voices shouting out her poetry. We put on her favourite music. She breathed very loudly. Even now I awake with a start, hearing that noise. Her body was in pain, the morphine didn't quite cut it.

In the end, the last words she said were: "Is it my birthday today?"

It was a good death, as death goes.

But, please, don't sugarcoat dying at home. Don't be led by the nose to doing something alone that should be an event where there are people present who know what is supposed to happen: Yes, this is normal. Yes, take a break for a little while. Yes, let's let her go. No, the morphine isn't killing her.

A sane culture is one where babies are born at home, where midwives are discreetly present for the woman, her newborn, and her family. A sane culture is one where people can die at home, where death midwives are present for the dying, for the living, and for the continuity of the family and the community.

Freedom For Birth (Web version)

Birth

Women all over the world give birth in exactly the same way. They make the same noise when they reach the pushing phase; they move the same way; they touch their newborns gently and hesitantly during the few minutes after birth.
Midwives are the same everywhere too. They catch sleep when they can, love attending births, like the smells and sounds of the birthing room. We are happy when we see poo!
Gratitude and respect to all the women who are birthing today, and to all of their attendants. May it be a day of peace and joy.

Seven Billion!!

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

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

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

My vision is one of most women giving birth at home, with full medical back-up available to them if needed. Midwives would provide prenatal care and accompany the laboring women through labor and birth. They would assist with the postpartum period and help the new mother adjust to life with a new baby. If there were problems, the midwives would refer the woman to a doctor, who may in turn refer her to a specialist, an obstetrician. Full emergency support would be in place for the rare occasion that it is needed, so that the midwife would know that she is covered in the case of an emergency. 

The women who chose to give birth in the hospital, in my dream world, would be there because of clear medical or social need. The hospital birthing centers would provide specialized medical care for the few women who need it. Occasionally, there would be a woman who needs the extra emotional support of a doula, but the doula would be well-integrated into the hospital system and would be on call in these situations. Sometimes a woman would want to give birth away from home, and she could go to an independent birthing center which, again, would be fully supported in case of a medical emergency. 

I do not believe that this vision is so far off in the future, or that it is out of our reach. For now, however, our reality is that most women in the developed world are giving birth in hospitals, and many of these hospitals have different philosophies about birth than many of the patients they are there to serve. In Canada, the philosophy of any hospital must be to provide the best care for the greatest number of people. This may translate into an epidural for every woman, especially if there are not enough nurses to support each woman individually. In the USA, hospitals are run as profit-making enterprises, so the word philosophy may not apply. We do know, however, that cesarean section rates are skyrocketing, and that the general consensus is that a national rate of about 15% may be optimum. Personally, I believe that the rate for emergency cesarean sections can be held to 5% without putting the mothers or babies at risk.

The doula is the interface between the birthing community and the medical establishment. This puts us in a difficult position. I have spoken to  women who thought that I would leave them to give birth alone if they decided to take an epidural (this is beyond cruel). I have been yelled at by a physician who thought I had removed an intravenous drip (the nurse hadn’t had time to put it in). I have been looked upon as a knight in shining armor (I don’t even like horseback riding) by women who had not yet understood that the birth work is done by the birthing woman.

     I have also been thanked and cherished by hundreds of women who have been happy to have me by their side as they go through the experience of giving birth. My task, our task as doulas, and in a bigger sense, our task as human beings in the 21^st century, is to “humanize” birth. To me, that means affirming that all of us are different, and that we all have needs, desires, and histories that cannot and should not be judged. My job as a doula is to create a space in which a woman can reclaim her knowledge of birth and give birth according to her own birthright.

Illegal Midwives part 2

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

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

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

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

Illegal Midwives?

"Illegal" is a word that brings to mind outlaws, bandits, drug runners, hoaxters and jails. I prefer to use the word "underground" when I am talking about the midwives I know who are working outside the (extremely limited) system of registration, colleges,and paperwork that is in place in most of Canada. I joke that they are underground - they'll only assist a woman in an underground parking lot or a basement. Ha ha.

In fact, the women working outside the system are not allowed to assume the title of midwife or sage-femme, which is why many of them describe themselves as birth attendants or even as birth activists. The Montreal Gazette's story about this phenomenon presents some bare facts and portrays a sympathetic, sensible woman who has chosen to assist women who would otherwise be giving birth in a hospital with a doula, or alone at home. Not so say that giving birth with a doula isn't the choice that most women ultimately make. The doula's job is often a difficult one, because of this. She has to straddle compromises that are often unbearable to watch.

"Brave" and "courage" are often words I hear about the women who choose to give birth at home with a qualified, if "illegal", attendant (or "stupid" and "selfish"). But I think a woman is much braver who knows exactly the kind of treatment she may receive in a hospital, after she has already had an unnecessary cesarean section, and chooses to go back into that environment with a doula at her side, in the hopes that she will be able to give birth with dignity and autonomy.

The sad thing is, birth shouldn't have to be about bravery, about ego, about choices, the law, surgery, or drugs.Here is an excerpt from my upcoming book:

The other day I was at a birth. My client was a third-time mother and she didn’t want to be in the hospital for too long, but her previous two births had not been that short. So as she kept in touch during the day I agreed that she didn’t have to rush to the hospital. It was mid-morning when she decided to go, after having a bath and making sure her kids were settled. When the doctor examined her, she was almost ready to give birth. The birth proceeded very quickly, and afterwards, the obstetrician said “Oh, ladies like you will put me out of business!”

I would like to be put out of business. I would like the system to change so much that the privately hired doula is a thing of the past. Certainly, there will always be women who do not have anyone to accompany them at their birth, and for these situations we will have the volunteer doula associations that already exist today. My vision is one of most women giving birth at home, with full medical back-up available to them if needed. Midwives would provide prenatal care and accompany the laboring women through labor and birth. They would assist with the postpartum period and help the new mother adjust to life with a new baby. If there were problems, the midwives would refer the woman to a doctor, who may in turn refer her to a specialist, an obstetrician. Full emergency support would be in place for the rare occasion that it is needed, so that the midwife would know that she is covered in the case of an emergency.

The women who chose to give birth in the hospital, in my dream world, would be there because of clear medical or social need. The hospital birthing centers would provide specialized medical care for the few women who need it. Occasionally, there would be a woman who needs the extra emotional support of a doula, but the doula would be well-integrated into the hospital system and would be on call in these situations. Sometimes a woman would want to give birth away from home, and she could go to an independent birthing center which, again, would be fully supported in case of a medical emergency.

I do not believe that this vision is so far off in the future, or that it is out of our reach. For now, however, our reality is that most women in the developed world are giving birth in hospitals, and many of these hospitals have different philosophies about birth than many of the patients they are there to serve. In Canada, the philosophy of any hospital must be to provide the best care for the greatest number of people. This may translate into an epidural for every woman, especially if there are not enough nurses to support women individually. In the USA, hospitals are run as profit-making enterprises, so the word philosophy may not apply. We do know, however, that cesarean section rates are skyrocketing, and that the general consensus is that a national rate of about 15% may be optimum. Personally, I believe that the rate for emergency cesarean sections can be held to 5% without putting the mothers or babies at risk.

The doula is the interface between the birthing community and the medical establishment. This puts us in a difficult position. I have spoken to  women who thought that I would leave them to give birth alone if they decided to take an epidural (this is beyond cruel). I have been yelled at by a physician who thought I had removed an intravenous drip (the nurse hadn’t had time to put it in). I have been looked upon as a knight in shining armor (I don’t even like horseback riding) by women who had not yet understood that the birth work is done by the birthing woman.

I have also been thanked and cherished by hundreds of women who have been happy to have me by their side as they go through the experience of giving birth. My task, our task as doulas, and in a bigger sense, our task as human beings in the 21^st century, is to “humanize” birth. To me, that means affirming that all of us are different, and that we all have needs, desires, and histories, that cannot and should not be judged. 

I fully support those women who choose to give birth at home, who choose to assist others at home, and who choose to follow a different path. My only condition, however, is that birth attendants keep their egos, their pride, and their ambitions out of the birthing room, and indeed, out of the process. That way, knowledge of the craft can be the highest priority, assessments can be made honestly, and difficult decisions are not clouded by personal needs.

Two of the most famous midwives, Shifra and Puah, were "illegal"; they disobeyed the Pharoah of Egypt to assist women at home ... power to the women who follow in their footsteps! May we merit to be midwives to a better way of giving birth.