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!

Meconium Happens

The more I live this life, the more I am convinced that the deal is, it is not what happens to you that matters so much, it's how you accept it (or not). I have been to births that have been really challenging and tough, where the woman accepts the labor and is thrilled with the whole experience. I have seen other women fight against labor and birth, one contraction at a time.

Today is December 6, 2020. A day like any other. Except not: it's the anniversary of the day when 14 women were killed by an armed killer.

It's a day when my friend had to go back into hospital. It's a day when thousands of people died from Covid-19.

It's a day when we have to, as always, take the joy from every moment and cherish it. And even when we are full of joy, and all comfy in our enlightenment and entitlement, shit will happen. Meconium does happen. A baby can suffer some small slight and poop. Or a baby can get their cord squeezed so much they poop a lot. Things break down, things break. People break. 

But where there's rupture, there's repair. A body's urge is to health, just as a plant moves towards the light. In the same way, the knowledge of women has always been towards healing. 

We can't do anything to bring those women back to life. But we can speak out against violence every single day. And, unfortunately, in my field (haha no, not in my cafe...in my real field which is maternity care), violence against women is rampant, ugly, and expected. 

What can be done? Well, one thing that's happening is that pregnant women are rising up and saying "No more violence! No more treating me like I'm a child, that I don't have feelings, that I don't know my own body. No more speaking about me as though I'm not present. No more making decisions about my body without my consent. No more doing things to my body without my consent. No more lying to me!" And how are these women doing that? By withdrawing from the hospital system. They are giving birth on their own or with Traditional Birth Companions. 

Another thing that is happening is that doulas are continuing to support women who choose to give birth in the hospital. Or, more importantly, those women who don't actually have the choice and have to give birth in the hospital. Especially these days, it's hard to be a doula. Many hospitals have taken away the birthing woman's right to support by insisting that she choose between her partner and her doula. So doulas are providing companionship and support virtually. 

Medical staff in hospitals in today's world are stressed. They're overworked, tired, and they have all the same concerns on their minds as you or I. Suicide rates are higher for physicians than for the general population, and higher for female doctors than males. The medical system isn't working for anyone.

What can a doula do to relieve everyone's symptoms? Let me be clear: when a doula works to facilitate a mother feeling empowered in a situation where her power can be taken away from her at any minute, we are not talking about getting at the root of the problem. If a birth is an undisturbed birth in a place where the birthing woman is comfortable, safe, and respected, then the doula can do the work of being a doula: easing labour, providing encouragement, seeing to the birthing woman and her family's needs. But if a birth is taking place in an environment where the go-to routine is medication, management and directives then the doula can only provide bandaid measures within a strict and abusive system.

And these bandaid measures can work! Any number of women leave the hospital with their babies feeling joyful, even ecstatic, and satisfied with their care. But a huge number of women leave the hospital hurting.

Is it time to finally step away from an abusive system? What happens to a woman when she has a vision of a natural, normal birth and she arrives at the hospital and things start to go haywire? Is it possible to convince women to stay at home, at least until they are in active labor? What about the woman who feels every contraction, from the very beginning, like torture; the woman who can't separate her labor contractions from an abuse she experienced years ago? What is the role of the doula through this seismic change? What about midwives? Why are midwives still using the words "should" and "allow" when they speak about birth? 

Is it time to Rise Up?

Birth and Scars

As we grow, we absorb big and small shocks to our bodies and souls. We all know where our physical scars are, and we often assign stories to them. I remember when I was skipping school and the knife chose that day to slice my finger, so I had to get myself stitched up without (I dreamed) my mother finding out. I have a little white line on my finger that tells that story.

Some women have bigger scars, on their skin and their muscles, from birthing their babies. I hear these stories often when I am speaking to women about their birth experiences.

Other women have emotional scars that last for years. These scars have a way of aching and burning during pregnancy and birth. The doula can gently assist the woman when she is feeling these aches and pains. Doulas are not therapists so they do not have to probe, suggest, or hypnotize. What they do is provide a non-judgmental ear, if the woman wants to talk. They let her know that she is not alone, that she has support. They also remind her that there are other women who have traveled the same road and survived.

One of my students is accompanying a woman as I write. The woman has been in labor for most of last night and today. She does have emotional scars, and they are hurting. My student has been with her the whole time, supporting and comforting. And even though my student is a very inexperienced doula, she is still providing the essence of what a birthing woman needs. The expertise, medical know-how and scientific facts is not the realm of the doula. She is there with other skills: the skill of touch, listening, compassion, and presence.

With our world changing every day; with our experiences and our innate wisdom challenged every single day; with our routines and habits changing minute to minute, we are starting to see between the lines of our lives. We are starting to look between the cracks; to probe between the layers of darkness that we have been hiding behind. We, as women, are starting to see what has been hidden: that birth is a unique act, unique to women; that women's bodies are exquisitely designed for this task; that a woman births best when she is surrounded by a loving circle of care.

It is wonderful if that circle of care can include someone, an elder perhaps. who know about the vagaries of Mother Nature and her cruel jokes. But if not, chances are that everything will work out fine. And that is better than being treated like a child, when you are bringing forth new life.

So I see women and their partners and their communities going about their lives, far from hospitals and Covid regulations. And it makes me sad that with this huge machinery of health care that we as a society couldn't have created a safe and sacred space for women to birth in; but I understand why that isn't possible. Can you imagine what would happen if the power of womanhood was actually unleashed? 

Think about the biggest wave you've ever seen. Think about the most love you've ever felt. And the most beautiful place you've ever been. Imagine what it would be like if women grew babies in their wombs and birthed them with respect, honour, and love. 

Scars have a way of healing. With healing comes change, and growth. Womanhood has been injured and scarred for too long. There's a new era coming, so watch out!

COVID19 in-house Day 22: Birth and Choice

My dear friend Syd reminded me of something the other day when she suggested we all stop talking about "lockdown". Lockdown is something that happens is prisons. It's a scary situation when all of your freedoms are taken away. What we in Canada are living through now, most of us anyway, isn't that. It's scary and several of our taken-for-granted freedoms have been curtailed, but we are not in "lockdown".

I would like to take a minute to think about all the people who have had their lives deeply shaken by this pandemic: some people have lost their lives, others have lost loved ones. Some people's futures are changed beyond recognition, other people's present lives are changing as quickly as thought. In some countries, the biggest risk is starvation because there's no way to get out to get food and no way to make a living. In others, people are struggling to get by on what little they have.

But all of us in this world, together, are living through this historical event, whether we like it or not. We all have to figure out creative ways to live, to rise up to the new challenges we are faced with. Here in Montreal, most of the people I know are staying home, except for the health workers amongst them. Those brave souls are out in the hospitals and clinics, keeping us healthy, providing for the sick, and juggling their own lives and families with the needs of others.

I worked as a birth attendant for twenty years, and I trained doulas for fifteen of those years. One of the qualities I always valued in a student doula was flexibility. If a doula has that quality of making virtue of necessity; if she can take a challenging situation and make the best of it, then I am confident that she will provide the very best care for her clients. It's tough, sometimes, when a client wants her birth to go a certain way, and you as her doula know that it's unlikely that it's going to go that way. It's tough when your client is going to birth in a hospital where you know that the protocols don't "fit" with her beliefs about birth, or when things take a turn and interventions are needed. In these situations, I teach my doula students a few main lessons.

The first one is: when you and your client enter into the hospital, you are entering someone else's home. In the hospital, you don't make the rules. When you're in someone else's "home", you follow their rules. When your client is in labor is not the time to try to change the rules. A birthing woman should not have to spend her labor time battling with her attendants. She should have a realistic idea of what will happen. If she doesn't agree with the rules, then she should make other arrangements.

The second rule is: as the doula, you are there to support your client throughout the journey. In every scenario, with whatever tools you have at your disposal. Again, now is not the time to argue with the medical staff. Now is the time to concentrate on accompanying your client as best as you possibly can, so that their experience will be positive.

The third rule is: love your clients, love the staff, love the birth experience, love the baby. The more love you can spread around, the better.

Two major maternity wards (also here) in Montreal announced this week that because of Covid19, patients giving birth would not be allowed to bring anyone into the birth room. Not a doula, not a partner, not a mother. This has sparked a huge controversy and many people are angry, many are worried about how their birth will unfold, and petitions and news articles are all over the social media.

I do understand how scary it is to give birth alone. I've done it, in a foreign country, and it's not pleasant. (Actually, that's an understatement. It's traumatic and awful. But I didn't have a doula, and I didn't speak the language.) I believe that the maternity care system here in Quebec is broken: it's been broken for a long time - there aren't enough midwives; the laws around midwifery care were badly conceived; the maternity wards are understaffed and overly restrictive. In twenty years, I've heard many, many awful stories about giving birth in Quebec.

But this is the worst time to start to fix it. The worst time to try to change it. The worst time to push against a policy that actually will save lives.

It's a difficult time to give birth. It's a difficult time to stay alive. It's even a difficult time to die, as funerals are restricted. But this is a time when we can use all the resources we have to make our experiences better. So, doulas, I am calling out to you to do your very best work, and prepare your clients with love and compassion so that they can look forward to their birth with joy, and they can enter the hospital knowing that, yes, they will be cared for. The nurses are in fact there to care. You will be FaceTiming them from your home, guiding your client with your voice, letting them know that you love them, that they're doing a great job... using all the skills and creative tools at your disposal in the trying times.

After this is over, let's fight together for decent maternity care! Let's make a note that, yes, maybe hospitals should be for sick people and birth belongs somewhere else. Let's fight for more midwives, for more birthing centres, for an understanding of pregnancy as a normal, healthy event. But let's save that fight for later. For now, let's try to live together, with love. Doulas, be creative! Use your voice to provide support for your clients, where they are.

In these complicated and challenging times, let's pool our resources to work together! Spread the love!

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!

Birth Drugs

Just say no? Of course not!

Drugs save people's lives. Antibiotics, antiretrovirals, opiates, anesthetics, statins .... the list goes on and on. Every day, millions of people are kept alive by modern medicine and by appropriately prescribed medication.

In obstetrics, however, as in psychiatry, medications are overused and used inappropriately. The other day I heard a story about a woman who needed surgery like she needed a hole in the head. She is alone, poor, and anxious. She was going to have a difficult entry into motherhood without major surgery, dealing with the stress of a newborn along with the continued stresses of poverty and cultural isolation.

She was scheduled for an induction and her uterus reacted too strongly to a Cervidil insertion and started hyper-contracting. Baby went into distress and surgery was needed to save the baby. 

I would need a crystal ball and a full-on fortune telling kit to figure out if this particular mother-baby dyad would have needed surgery if left alone. But it is true that "Care providers need to consider that induction of women with an unfavourable cervix is associated with a higher failure rate in nulliparous patients and a higher Caesarean section rate in nulliparous and parous patients" (SOGC).

Why are we giving drugs to laboring women? I took a picture of this drug the other day. It is called synthetic oxytocin. It can save women's lives if they are experiencing a serious postpartum hemorrhage. But it is used much too often to speed up or stimulate labor in cases where a good dose of patience is all that is called for.

This is a high risk drug!

Another cocktail of drugs that is commonly administered is the epidural cocktail. The components vary from hospital to hospital. You can find detailed information on the most common ingredients here (page 20). Most epidurals do contain Fentanyl (see below), which is an opiate. I have never heard an anesthesiologist ask a laboring woman if she has a history of substance addiction, but most recovered addicts I know would not willing put an opiate into their bodies unless they really had to.

Which leads me to the next question, which is: when is it necessary to give pharmaceutical medication to women in labor? And I would like to suggest that the answer should be: when the pharmaceuticals are directly involved in saving the life of mother or baby or both. 

We simply do not know the long-term effects of epidural medication on the baby.  

And no, I am not speaking from a pedestal of wonderful candle-lit home births here, either. I have experienced my fair share of birth trauma. And yes, I am fully aware that taking an epidural during labor is often very important for the woman's emotional and psychological well-being, and her sense of empowerment. But these drugs are becoming normalized and their effects minimized. I would like to see the brake put on this candy store mentality where we are offering dangerous drugs to women and newborns.

Here is a brief description of one of these candies:

Fentanyl is a powerful synthetic opiate analgesic similar to but more potent than morphine. It is typically used to treat patients with severe pain, or to manage pain after surgery. It is also sometimes used to treat people with chronic pain who are physically tolerant to opiates. It is a schedule II prescription drug.

In its prescription form, fentanyl is known as Actiq, Duragesic, and Sublimaze. Street names for the drug include Apache, China girl, China white, dance fever, friend, goodfella, jackpot, murder 8, TNT, as well as Tango and Cash.

Like heroin, morphine, and other opioid drugs, fentanyl works by binding to the body's opiate receptors, highly concentrated in areas of the brain that control pain and emotions. When opiate drugs bind to these receptors, they can drive up dopamine levels in the brain's reward areas, producing a state of euphoria and relaxation. Medications called opiate receptor antagonists act by blocking the effects of opiate drugs. Naloxone is one such antagonist. Overdoses of fentanyl should be treated immediately with an opiate antagonist.When prescribed by a physician, fentanyl is often administered via injection, transdermal patch, or in lozenge form. However, the type of fentanyl associated with recent overdoses was produced in clandestine laboratories and mixed with (or substituted for) heroin in a powder form. Mixing fentanyl with street-sold heroin or cocaine markedly amplifies their potency and potential dangers. Effects include: euphoria, drowsiness/respiratory depression and arrest, nausea, confusion, constipation, sedation, unconsciousness, coma, tolerance, and addiction. (National Institute of Drug Abuse (2012). Fentanyl Retrieved from http://www.drugabuse.gov/drugs-abuse/fentanyl on September 23, 2014)

Birth and Pleasure!

Here are some highlights from the Birth Companions/DONA workshop with Debra Pascali-Bonaro last weekend. We started out sitting around in a circle, with notebooks at hand, listening intently to what Debra had to say...

Day One, Hour One

The room started to get a little messier and we all moved in closer to Debra, and to each other, as we started to get into her words and the concepts we were exploring together.

Moving Closer

Group Work

Debra explaining about positioning. As I was saying - Birth is Simple! An introduction to the concept of pleasure during the childbearing year.

As the days progressed, we got to know each other better through working in groups of two, three or more. Women came from Nova Scotia, Quebec, and Ontario to participate in this gathering, and from such different backgrounds! But we found common ground and really connected.

And That's It! Debra brought her birth cards out - a wonderfully innovative tool that really helps the new parents to imagine and understand what their options may be, and how one choice will have consequences on how the birth will unfold. The students played with these cards to learn how a doula can help the new parents to make choices prenatally.

Working with the birth cards

I Love You  Taking the time to treasure each other and ourselves.

WomanPower!  We learned important techniques to use during labor and birth: the rebozo was a favorite! And of course the messiness of the room was no longer a consideration. We were getting down to the ground and having a good time! Shimmying with a rebozo Through active role play the students learned how they might act with a real woman in real labor. They used props such as birth balls, rebozos, and learned about positions in labor, prenatal positioning, and some massage work.

Shake and Lunge!

 This useful tool hangs on a door (make sure it's locked!!) and a laboring woman can pull on it as she squats.

Deep Squat

 Finally, on Day Four, our babies were ready to be born. Our doulas comforted each other through active labor and used all the techniques they had learned during the final role play. They used birth balls, rebozos, positions, physical comfort measures, and a lot of vocalization! The room was alive with woman sounds: moaning, yelling, sighing, and laughter!

Thank you to everyone who made this workshop happen!

The Curse of the Black Crow

I had a student a few years ago who was attending births with me, and every one of the first six births she attended ended in a c-section. The sixth time, she ran out of the room and down the hall, convinced she had somehow caused the natural birth to go sideways into the operating room.

A friend of mine was standing in the hall, a family physician with a heart of gold, and she caught my student and looked her in the eye, and told her "You do not have the curse of the black crow!" and proceeded to explain how difficult it is for a care provider to accept that their patient's journey is sometimes not what anyone has planned, and that most of the time it is not the provider's fault.

I was taking care of my sister, who was in the hospital after a difficult surgery and several setbacks which were scary for her and worrying for us. She finally made it out of the grey place and we were sitting talking to the surgeon, who apologized to my sister for the fact that things had been more difficult than expected. When my sister reassured her that she had no feelings of blame, and further that the surgeon wasn't responsible, she replied, "Oh no, but I AM responsible. The buck stops here".

But it doesn't. The attendant has a huge responsibility, indeed, to care for her patient. She needs to do everything she can to facilitate healing, or in the case of childbirth, to carefully observe nature at its task. But if she has given her 100%, she has to know that there is always that element of mystery involved. The buck does not stop with us. We do not know why one woman will have a three hour painless labor, and another one will struggle and strain for two days. Yes, we can read blogs galore about how the happy, accepting woman who is comfortable with her body and open to experience will have a quick and easy birth, and the resentful and complicated one is more likely to have a c-section. But these easy generalizations are not true.

No, we don't know why some women have easier births, or why some surgeries end in easy healing and some don't, or why some treatments work on some people and not on others.

When you really believe that the buck stops with the surgeon, then you are closing a door to the mysteries of healing and the mysteries of life.

Trust Birth?

I read a post on the ubiquitous Facebook the other day about a triumphant birth. A woman and her husband went to the hospital with their doula. The woman laboured with the support of those around her - her doula, husband, and the medical staff. She required no drugs, no medical interventions at all. In fact, she had a natural birth in a hospital setting. Which is wonderful, joyful, and, unfortunately, increasingly rare.

Why did she have a natural birth? Was she lucky? Did she just happen to have the right combination of a good pelvis, an agreeable baby, health, happiness, strength, the right medical staff, and good timing? Or was it really because she did a prenatal class that was somehow better than any of the other prenatal classes out there? Or was she determined? Or was she a positive thinker? Or did she have some good karma coming her way?

Probably a little bit of all of the above. When I am working with a woman I feel confident about, she has a good combination of strength, flexibility, confidence, vulnerability, self-knowledge, and a touch of who-gives-a-shit. She may or may not have an amazing support system and wide hips. She may have had a terrible childhood, and she may not be a very nice person. She may be having trouble in her relationship. She may have a lousy relationship with her mother. She may be tiny. She may be fat. She might not eat too well.

But there is a certain woman power that she will have, that will come out when she is birthing, that reassures me that this woman will not be too much of a challenge during and after labor. I am confident that labor will unfold, it will be powerful and most probably painful. It may make her feel like she is going to die, but I will be able to keep her to her path.

Most doulas, midwives, and physicians can tell you that they have a sense of a woman who is heading for a natural birth, if she is given the chance. The problem with most hospital births these days is that very few women are even given that chance. The epidural rate for first time mothers in the hospitals in Montreal is over 90%. That is no chance at all, for a woman who is feeling labor for the first time.

So, as the Muslims say, pray to Allah, but tie your camel to a tree. That is, don't rely on faith to make things happen for birth. Although much of it is chance, or fate, karma, or the divine, what is left over is human intervention - or human strength - or woman power. Let it shine!

Natural Birth Workshop in Halifax, NS

Contact the Nova Scotia Doula Association for details.

Update

Just to let y'all know - the volunteer doulas texted me at 3pm, our lady was going to have a sandwich and a lie down - then I didn't hear until 7pm - Baby Girl!!!

Quick and joyful natural birth. Thank you all for the collective toe pointing.

The doulas went home happy and will be back today to visit the new mother. They will visit her over the next week to make sure the breastfeeding is going well, and to talk over the labor and birth, and share in the joy.

Volunteer Birth Companions

I am very happy my book is selling - by the way, people, it would be a very nice Christmas or Hanukah gift for any of your close friends or relatives who are expecting a baby in 2012.

Please visit Amazon to review or "like" my book.

I want to tell you about the Montreal Birth Companions. This is a group of very special women who accompany underprivileged women  during their labor and birth experiences. Most of our doulas are just starting out, but some of them have been working with us for years. They are all volunteers, working out of their own pockets and from the goodness of their hearts to help other women have a joyous birth experience.

One of "my"doulas has been volunteering for months, doing her own research, studying,doing courses with different organizations and waiting for her time to accompany a woman in labor. Finally, yesterday, I got a call from a nurse to tell me that one of their patients who is alone here in Montreal was in labor and wanted a companion.

Our doula rushed to the hospital, where she witnessed a beautiful natural birth and was able to provide comfort and companionship to a birthing woman. She is hoping to be accepted to midwifery school this year, and I hope she gets in. She is a natural!

Book Launch!!

Michel Odent in Montreal

Michel Odent came to town the other day, and I was very interested in finally hearing him speak. I first heard about him when I started learning about natural birth, twenty five years ago. His accounts of natural birth and his respect for the birthing woman seemed legendary among some circles, so I was eager for a first-hand impression.

The talk took place in a huge imposing building, on a cold, windy, and rainy night. The hall was a good size, though, so the audience was packed in and everything seemed cozy. I saw three or four men in a huge sea of women, and there were enough babies there to make a considerable noise at odd moments during the talk.

As a radical old feminist, I was uncomfortable with the dynamic of the evening. Here were over one hundred women, of all shapes and sizes and ages. One lady wore a head covering; a couple of ladies were different colors. And here is a man, old enough to be our father, or even our grandfather, telling us about what our bodies could and couldn’t do! And we were all lapping it up, eager to ask questions, eager to be spoken to by the expert.

I appreciated one point that M.Odent made. He said that the traditional midwife not only is witness to the births of generations of babies, but she is also the transmitter of information from generation to generation. We tell the younger women we attend what we know about birth, about babies, about children, about how to treat your man, about herbs and healing, about grief and dying. I feel the weight of that responsibility every time a woman calls me to ask a question. We are the keepers of woman knowledge. We keep knowledge in our breasts, in our uteruses, in our scars and in our hearts.

M. Odent spoke of the nature of natural birth, and the difficulties women in our culture have with the process of natural birth. “Natural Birth” has become a buzz word, a goal, and through and because of this popularity, it is becoming more and more misunderstood.
I agree so far. I agree with M. Odent that a truly natural birth is a birth during which a woman is simply giving birth. A birth during which her body takes over, when she has no more control over it than when she is digesting her food. The body takes care of itself. The baby wants and needs to be born; the uterus obliges by making contractions, the cervix opens, e violà! We have all witnessed births like this, and we do well to identify these births as normal and natural. A first time mother usually takes about 6 to 8 hours to birth, and multiparas take much less time.
I agree as well with M. Odent’s suggestion that the presence of the woman’s husband (does that include lesbian women’s partners?) can actually have a negative effect on labor. About one third of all the births I have attended have been with women whose husbands stay out of the birthing area. These women tend to give birth effectively and easily, but there are other factors involved.

So what is the problem? Why do we have women laboring for days in the hospital? Why do the babies not come out? How can all these babies get stuck? Why is our surgery rate so high? Why does everyone else end up with a second-degree tear?
M. Odent says that a woman needs to be able to labor within a protected environment, where her neo-cortex is not activated with silly questions, and she feels free to do what she needs to do. Every doula knows that this is part of what we try to provide for the mother when she is laboring. If we are at home with her, we like to rest in the armchair as she labors. If we are in the hospital, however, the dynamic changes and we do need to become protective of the birthing space. For this reason, we like women in labor to go to the hospital as late as possible in their labor, which gives her body a better chance to get into the birthing mode, with full-on oxytocin and triple shots of the birthing cocktail.

M. Odent stated that “oxytocin is timid”. I disagree. I believe that characterizing oxytocin, which is thought of as primarily a female hormone, in this way, is to do women yet another disservice. Oxytocin isn’t timid! I have watched so many women birth their way right through all sorts of ridiculous situations, with their oxytocin going strong. I have seen women answering questions and filling out forms while their oxytocin gets the baby ready to be born. I’ve seen women pushing in the elevator, with people asking them if they need a wheelchair.
No, oxytocin is not timid. There’s something else happening here.
Let us remember that in this world, as soon as you observe something, it changes. So whatever you are witnessing at a birth has been changed by your act of observing. The less we observe, the better off the birthing mother will be. If I am there with a woman, as her friend, sister, or mother, I can mitigate that difficulty by entering into the birthing woman’s world.

M. Odent went on to decry the masculinization of childbirth, and suggested that our culture’s obsession with a dysfunctional sexuality is at the root of the de-naturing of childbirth. Again, I take exception to this interpretation.
Let me propose another explanation:
We live in a hypersexualized society, where young people are expected to have their first sexual encounter before they turn sixteen; where Viagra is advertised on prime time TV; where any seven-year old can access movies of sexual acts on a cell phone; where marriage is temporary and our private sex life is grist for the public mill.
At the same time, though, real sexuality, the vibrant, living, and intimate communication with one another, is shunned and feared. Pictures of breastfeeding mothers are banned from Facebook, and regularly purged. A long and fertile marriage is caricatured on national radio (“Who wouldn’t need Viagra when their wife is old and wrinkly?”). Women in labor are silenced with epidurals or breathing techniques.
Our culture is afraid of childbirth. Men have always been afraid of birth – remember, only the woman knows who the father of the baby really is. The miracle of birth - bizarre, shocking, and extraordinary – is difficult for men to accept. They are shaken by it. It moves them in ways they do not appreciate.
But how can I say what men feel? Who am I to theorize about how a man feels when he sees a baby come out of his wife’s vagina? How can I, as a woman, presume to imagine what a man feels at this elemental time of his life?

We are a culture full of fear. We are afraid of terrorists, of viruses, of weight gain, financial ruin, cancer, mold, in fact, we are afraid of our own shadows. We have been “rimbambolito”, reduced to doll-like proportions, by our media, by the conclusions we have drawn, by the absence of real mothers and fathers. Women in particular need to grow up, and we need to take back our own voices and our own bodies. If a man feels the need to take Viagra, so be it. If he tries to tell you that your own body is “timid”, shout him down.
Birth is powerful, duh.
Women are strong. Life is good.

Doula Love and Accountability

I have raised a lot of eyebrows with yesterday's post so I would like to go back and comment and try to clarify. One message I was sent was this:
"Doulas don't cause Cesareans. Emphatically. Doctors, emergencies, and women's choices do."
Yes!! Absolutely! And we, as doulas, need to remember this. It is ALWAYS the woman's birth, and not the doula's. No matter where the path leads, it is the doula's mission to follow, and to respect and nurture the woman she is accompanying.

Another message went like this:
"When I'm at a difficult birth, even though I've only been practicing for a few months, I know that I am providing something that no one else can, and that is unconditional support. I know that I'm not responsible for the outcome of the birth, and I hope you realize that inexperienced doulas may take your words seriously."

Still another:
"Yes, we need to take responsibility for what we do - and if a woman in my care has an unnecesarian, I take responsibility, I try to work through it to improve my care."

Wow! Please comment on my blog. I appreciate your messages but I would like to make this discussion public.

To clarify, I would like to publicly apologize to any young/inexperienced doula who was hurt by my words. That is the last thing I wanted to do. I would like to engage in an ongoing discussion about responsibility and transparency. How do you feel when your client has an unexpected outcome? How do you feel when you have a feeling she will end up in surgery, even though she is planning a natural birth? Do you change your practice? Do you call in a more experienced or differently trained doula? What do you do when you are at a birth and things start going haywire? Do you reach out to other doulas?

Whenever I am at a birth that ends in an unexpected c-section, I always look back at my actions and the prenatal and labor process to see if I could have worked differently. Sometimes I know I did everything possible. Other times I know I could have done more. I know as doulas we are not held accountable, as medical professionals are. We form associations and collectives but we are accountable, in the end, only to ourselves. I know I am very hard on myself, always wanting to do better, and I would do good to accept that meconium happens.

To all of you, keep up the good work, and keep on loving.

Blessings

I went to bed happy last night, because every Sunday I get to play jazz clarinet with a small group of amateur musicians (and one professional to glue everything together).

I read for a bit, Adam and Eve, by Sena Jeter Naslund - an interesting read. I put my head down and within five minutes my phone rings and a lady's water has just broken, very exciting, water everywhere. "Just like in the movies," she said.

All is good, I suggest she try to sleep a little. We spoke a few times during the night, as she was having some contractions, but I continued to suggest she sleep as much as possible.

In the morning, she call to tell me that she and her husband have decided to go to the hospital, where the news is that her cervix is not dilated, and they are going to try Cervidil to "jumpstart" labor.

Just asking all you folks out there, whether you're "in the know" or not, to throw a blessing her way. Just throw it out, and if it doesn't land on her, it'll land on another birthing woman...

Se Non Ora Quando

This was the rallying cry for the women of Italy during last week's demonstrations. It means "If Not Now, When! Except I think it sounds so much nicer in Italian.

Se non ora, quando?
 
If you don't breastfeed your newborn, then when will you get that chance again?
If you don't play with your two-year old, just remember, he will never be two again.
If you don't kiss your partner this evening, you will miss that one extra kiss.

If you don't speak up for what you need when you are giving birth, you will lose a world of satisfaction and gain a world of regrets.
The time for change is now.
If you are pregnant, decide what you want for your birth and go for it! Don't let the experts tell you what to do. Remember, the experts are not only the doctors - every nurse, midwife, and lady in the grocery store will be telling you how you should give birth.
If you are a doula, keep your opinions to yourself and let the women speak out! Respect the women giving birth and follow their lead. Change comes slowly and powerfully.

Se non ora, quando!

Volunteers

Some women do it for money, some do it for love, some do it out of a sense of duty.
Well, the Montreal Birth Companions volunteer doulas just do it out of their own big hearts - and I look at these women and feel very proud.
Several years ago, some of our doula students decided to start volunteering their services for needy women who could not afford a doula.
Now, in 2011, this small group of dedicated women is officially known as Montreal Birth Companions. This month we are following ten women. Most of these women are single and isolated. All of them are grateful for the companionship and assistance of a doula, and they know that the presence of a doula at their birth will reduce the risk of unnecessary intervention.

Yesterday, one of the MBC clients gave birth with the companionship of a newly-trained doula. She had her baby quickly and easily, in just a few hours. Last week, one of our "veteran" doulas accompanied a first-time mother for over a day as she labored to give birth.

The Montreal Birth Companions accompany women from many different backgrounds and cultures. Many of them are alone here and new to the cold Canadian climate. The presence of a doula helps them adjust to life here, where isolation is the biggest enemy. Social programs help our clients to eat and find warm clothing, and our medical system works well enough (more on that later!) that they get medical care when needed. But the companionship of another woman during pregnancy and childbirth is a gift that facilitates the transition to "mother" and fills the newborn days with joy and hope.

Il Glicine e La Lanterna

Let me tell you about where we will be hosting our New Doula Workshop this July. You will be staying at a small, family-run agriturismo called Il Glicine e La Lanterna - the Wisteria and the Lantern, set in the most amazing countryside in a northern corner of Tuscany. The area is called Lunigiana, and the name comes from its origins. The Luni were a mysterious people who created enigmatic statues that still intrigue historians and tourists alike.
It is believed that the Luni worshiped the moon, and that is easy to understand when you are witnessing the rising of a red half moon, as it emerges from behind the Appenini. The countryside is so stunning because of its variety. The area where we will be is bound by the Alpi Apuane on one side and the Appenini on another. The valley of the Magra river snakes down to the sea, which is only about 45 minutes away. Beyond the hills lie the Cinque Terre, an area of beauty and magnificence where vineyards climb the cliffs rising from the sea.
The hills above the agriturismo, where I am fortunate enough to have a small house where we  spend as much time as we can, are full of chestnut forests that harbor mushrooms of all kinds, wild boar, and many species of medicinal herbs.
I believe that it is important to learn about birth in a beautiful place; to learn about herbs where they are growing; to reach your full potential in a place where you can breathe, rest, and heal as you are learning and studying.

Birth Blues

I am so excited about the upcoming workshop in Italy. I hope that this will be the beginning of something really special for the women who will be attending.

I have the birth blues today because I have been talking to several women who feel sad about their birth experience, even though they did have a doula with them.

One woman felt that her doula was so against the epidural that she didn't call her until she had already been in labor for almost a day. She was afraid of her doula's anger.

Another woman had a natural birth in a hospital, but she was bullied by the attending nurse the whole time she was actively laboring.

I was at a birth the other day and I felt that my knowledge of the birth process was almost getting in the way. I felt the attending resident was trying to prove how much she knew, and was intimidated by my presence.

The doula needs to be rebirthed. She needs to go back to her original companionable self: the hand-holder, the friendly presence,  the holder, the invisible woman.