Sovereign Womanhood and the Misappropriation of Reproduction

We DO have so much power in us. So then how do we end up filing into our hospitals with our birth plans and coming out cut or broken, with a baby in our arms?

All over the world, and especially all over North America, women are finding new ways to birth in their own sovereign power. This can be terrifying. It can be fulfilling. It can be both.

I am speaking to old women who are attending birthing mothers as Traditional Birth Companions. I speak with younger women, mothers of young children themselves, who are devoting their time to attending the births of the women in their communities. I am speaking with women who have said "No!" to the maternity care system we have installed in our countries, and who are giving birth alone or with their families. I see sisters helping sisters. I see communities that are thriving, attending each other in birth, as in life.

Here in Canada, we have very strict regulations about what constitutes someone's right to provide care to a woman during her childbearing year. If you perform any of these restricted practices, without an officially regulated midwifery license, and without being employed by and liable to the health services establishment, then you are practising midwifery without a license.

Billie Harrigan is a Traditional Birth Companion in Ontario. She does not perform restricted practices, and she does not call herself a midwife. She says that Vaginal exams are rude, but also that they constitute a very clear message that our reproductive life and our bodies are not our property: they are the property of the state, and only people mandated by the state can invade them. Number 7 of the Ontario Midwifery Act states that vaginal exams are a restricted practice. In other words, you cannot put "an instrument, hand or finger beyond the labia majora or anal verge during pregnancy, labour and the post-partum period."

Ok, don't get me wrong here. I don't actually WANT to do vaginal exams. I also think they're rude. Not only that, my doula students have heard me say for years that the only reason for so many endless vaginal exams is that medical professionals are not taught about how sexual birth is. The sexuality and the mind-blowingness and the all-out intensity of birth is sublimated into rituals such as vaginal exams (actually, it is absolutely amazing to feel a baby's head in someone's vagina. Just saying. But I keep my hands to myself.)

But my point is, that women have been regulated for far too long. Our bodies have been misappropriated by a maternity system that pretends it is doing things to us for our own good, and it is not. Why do you think many a woman going into the hospital wants (or discovers she needs) a doula by her side? Because the doula can try to prevent some of the grosser abuses from taking place. But not all. And certainly not enough. Not enough to make the difference to so many, many women who feel that they have been violated (and they have!) when all they wanted to do was to give birth to their child.

So, what is happening? Just when the pandemic started making our lives more restricted and difficult, women started wanting to birth away from Covid-infested hospitals. We all, as our lives changed, started to take deep breaths and realize that we don't actually want to go back to the old "normal". I am getting weekly calls and emails from women who want to learn about new ways of birthing. I'm connecting with women around the globe who are moving forward to change the face of birth; to change the world, starting with birth.

Want to come on board? Come along!

“Come, come, whoever you are. 

Wanderer, worshiper, lover of leaving. 

It doesn't matter. 

Ours is not a caravan of despair. 

Come, even if you have broken your vows a thousand times. 

Come, yet again, come, come.” 

Rumi

And, if you are one of us who has indeed experienced trauma, abuse, and despair during your birthing, even more reason for you to move away from that reality, bring your scars and hold your head up high and cry out: "Enough!"

What is to be done?

You can listen to the Baby Magic Podcast for inspiration.

You can join my Traditional Birth Attendant seminar.

You can reach out to me or to any of the fine women on our podcast for community, information, wisdom.

You can reach deep into your womanhood and remember that you are strong! You are magical! I love you!

For those of you who have a legal interest:

Here are the restricted practices in Quebec:
"Any act the purpose of which is to provide the professional care and services required by a woman during normal pregnancy, labour and delivery and to provide a woman and her child with the professional care and services required during the first six weeks of a normal postnatal period constitutes the practice of midwifery. The professional care and services concerned consist in
(1) monitoring and assessing a woman and her child during pregnancy, labour, delivery and the first six weeks of the postnatal period, and include the provision of preventive care and the detection of any abnormal conditions in the woman or child ;
(2) conducting spontaneous deliveries ;
(3) performing an amniotomy, performing and repairing an episiotomy and repairing a first or second degree perineal tear or laceration.


In addition, in an emergency, while awaiting the required medical intervention or in the absence of medical intervention, applying suction, conducting a breech delivery, performing manual placental extraction followed by digital exploration of the uterus or performing resuscitation procedures on the woman or newborn also constitutes the practice of midwifery."
(http://legisquebec.gouv.qc.ca/en/ShowDoc/cs/S-0.1
In Ontario, they are much less vague:


"1. Communicating a diagnosis identifying, as the cause of a woman’s or newborn’s symptoms, a disease or disorder that may be identified from the results of a laboratory or other test or investigation that a member is authorized to order or perform on a woman or a newborn during normal pregnancy, labour and delivery and for up to six weeks post-partum.

2. Managing labour and conducting spontaneous normal vaginal deliveries.

3. Inserting urinary catheters into women.

4. Performing episiotomies and amniotomies and repairing episiotomies and lacerations, not involving the anus, anal sphincter, rectum, urethra and periurethral area.

5. Administering, by injection or inhalation, a substance designated in the regulations.

6. Prescribing drugs designated in the regulations.

7. Putting an instrument, hand or finger beyond the labia majora or anal verge during pregnancy, labour and the post-partum period.

8. Administering suppository drugs designated in the regulations beyond the anal verge during pregnancy, labour and the post-partum period.

9. Taking blood samples from newborns by skin pricking or from persons from veins or by skin pricking.

10. Intubation beyond the larynx of a newborn.

11. Administering a substance by injection or inhalation as provided for in subsection 4.1 (2). 2009, c. 26, s. 16 (1). (https://www.ontario.ca/laws/statute/91m31)"

Belonging and Ur: Thinking about Home

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

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

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

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

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

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

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

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

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

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

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

*from Philip Roth's masterpiece The Human Stain. 

Grateful for Dogs?

Even though I have a punk-rocker scar on my head where no hair grows from being bit by Skippy when I was a year and a half and I though it was my ball but clearly he thought it was his - and he paid dearly for his mistake! But anyway, even though that, and a huge scar my mother always had on her elbow from a badly trained guard dog in Uganda, even though these bad dogs bit us, I am now very grateful for dogs and in particular for Stella pictured above. She has taught me about unconditional love, playing, guilt, and determination.

Ok, there we go. So I'm grateful for D for Dogs.

But what I really wanted to talk about was D for Dreams. How we are molded and folded and ultimately completely remade by our dreams. How our dreams make us what we are and in turn we remake our dreams to fit the new person that arises whenever a dream turns sour or gets different, as dreams do.

My first dream: I wanted to dance forever on the sand, wearing little clothing and having the constant presence of my Ayah who loved me (but of course now I realize that she must have had a whole other life and that her caring for me and loving me was only part of the colonial myth that my parents were living).

My second dream: After getting yanked from Uganda to Calgary where it snowed and people wore a lot of clothes, I had a dream. My dream was to be an astronaut. I studied the planets and the stars, bought a telescope, kept a journal where I marked the positions of the stars, built model rockets, and made a small spaceship in my closet where I would head off to space every so often.

My third dream: Adolescence is a bitch. I realized life was hard and no one really knew the truth. I decided it would be a good idea to change the world. I thought I would like to be a doctor.

Then, things went crazy, life intervened, I travelled, had babies, married, and decided I wanted to accompany women in childbirth.

My Birth Dream: 

I studied midwifery and obtained my Certified Professional Midwife qualification. I started studying in 1988, when I was pregnant with my third son. I continued my distance studies for ten years, and then started working as a doula. In 2004 I started the CPM program, and in 2014 just after my mother died, I passed my final exam and became a professional midwife.

Yay!

Except ... except that I had miscalculated and I hadn't really grasped the reality of having a CPM qualification in Canada, where legislation requires midwives to be university trained in order to be licensed in order to work legally.

And now here's the big question: who wants to work illegally as a midwife? If midwifery is actually illegal, you can hone your skills and use your technologies such. as they are (Pinard horn, fetoscope, doppler, palpation, suturing skills, episiotomy if necessary, cord cutting and the like), and then if you really need to, there's always the hospital where you can pretend to be the birthing woman's friend.

But in a situation where midwifery actually is legal but restricted, that makes it much harder for anyone to actually monitor a mother and baby when things start to move outside of the norm. And, despite all sorts of people's convictions, I believe there is a norm that birth usually happens within. There's a certain time span when the woman feels certain things, when baby descends and then emerges. Within that norm, there's a ton of variation, and within that norm there's no need for intervention at all. But when things stretch outside of the normal, that's when the restrictions become dangerous and that's when our hands are tied. Because there are always women, and even more so now that Covid restrictions have made homebirth even harder, there are always women who want to birth their way, in their own home, with whomever they want present. And they call me to ask if I will be their "fly on the wall" in case something happens.

What? How can I fly do anything if the shit's hitting the fan? Granted, shit doesn't tend to unfold at a normal birth.... well of course meconium happens sometimes and mamas poop... but that's not what women are asking me to do.

Let's just use logic here: 

1. First, let's remember that the original "concept" of the modern doula was the result of a flawed study on maternal-infant bonding. One of the researchers had provided verbal support to the mothers she was observing, and those mothers had quicker and easier labours. So I guess if a mother is planning a "fly on the wall" kind of birth and she wants someone present to encourage and reassure, then she might want to hire a doula
2. What shit might hit the fan? What are women afraid of? I've asked women and they tell me they're afraid of hemorrhage, of the cord being around the baby's neck, and of something happening with the placenta. Partners are afraid the mother and baby will die. But if a woman is actually worried about these things, why would she place her trust in someone who is actually not allowed to do anything about it? Or does she think that her perfect birth is worth that other woman's livelihood, marriage, and possibly her home?
3. The unassisted births I've heard about either before or afterwards are those where the mother and her partners decided to give birth either on their own or with select family or with a doula present. NOT with a trained by handcuffed birth attendant. 

There are tough choices to be made, all the time, in the land of the living. I myself always seem to be figuring out exactly how to live on a knife's edge. Yes, I provide prenatal guidance and support. Yes, I have been a "fly on the wall". Yes, I train doulas to accompany mothers to the hospital. Yes, I will tell you that I believe you should call your doctor, or get to a hospital, if I think that is right. No, I don't believe that nature is particularly gentle. No, I don't trust women's bodies. Not after millenia of patriarchy have inflicted deep, deep wounds on our abilities to recognize when it's right and when it's wrong. 

Would I risk everything for a birthing woman? I have and I will. But not for random shit that's hitting a fan that we ourselves turned on. 

Today, I am grateful for Dogs.

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?

Manifesto

MBC Doula School Manifesto

A doula is … a birth attendant, who provides many and varied resources for the family-to-be during the childbearing year. This was a common role from ancient times up until the 20^thcentury, when it died out when hospital birth became the norm. Before hospitals were the places where women went to give birth, a midwife would attend a birthing woman in her own house and there was usually another woman or two, or an apprentice midwife, who would help with the extra tasks like giving the woman a back rub, or fetching warm cloths, or cooking some food, or encouraging the birthing woman when she needed it.

Back in ancient times, in some cultures, there was a circle of women who attended the birth and cared for the birthing woman carefully and with love. In other cultures, however, women birthed alone in a solitary hut and sometimes things went well and sometimes not. Romancing the past is not a good thing when it comes to the history of maternity care: maternal and neonatal mortality and morbidity rates have decreased consistently over the centuries.

Starting only about 150 years ago in the industrialized world, women started to go to hospitals to give birth. This created all sorts of problems, not least of which was massive levels of infection because medicine hadn’t yet discovered the important role that hand-washing plays in preventing infection. Just as importantly, women were going to the hospital on their own, separated from their families, and were being cared for by people they had often never met. By the mid 20^thcentury, hospital birth had become the norm, or at least a sign of wealth, in many parts of the world.

But there were serious problems with this alienated way of giving birth, and these problems are increasing day by day. Birth in the industrialized world has become a mechanical event, monitored by machines. Increasing rates of surgical birth have led to health problems in children. The cost of birth is rising. When this model is transferred to parts of the world where the infrastructure is not sustainable, the results can be catastrophic.

In the industrialized world, those of us who bear children feel alienated from the process of birth. This alienation makes us reach out to others who can perhaps accompany us through the powerful process of giving birth. We know that the presence of another person in a birthing room, who is not emotionally connected to the birthing woman, decreases labor time, decreases requests for pain medication, and decrease the use of surgical and other interventions. This companionship gives the woman a sense of peace that enables her to look back on the experience with more satisfaction.

At the same time, in most of the industrialized world, midwives have become a very small part of the maternity care team, and the huge majority of women go to the hospital to give birth attended by medical doctors. The doula enters into this world as a companion, a guide, and an advocate but doulas do not provide maternity care for mother and baby. The doula sometimes finds herself in conflict with the recommendations put forward by the doctor or midwife, but she cannot voice her doubts. She is a companion, a vessel, an advocate.

In the early 1970’s, Klaus and Kennell were doing research on the moments after birth. They were wondering how mothers reacted to their newborns; what are the consequences of how a mother treats a baby when the baby is born. How does a mother attach to a newborn? How does the newborn react to the mother? Are there lasting effects from these few moments after birth?

Their research shed light on another interesting fact, and that was that the women who were being observed were actually affected by the presence of the observer, and if the observer was encouraging and present, the labor time was shorter and the birth was easier.

The modern doula was born. The term was appropriated from the Greek. It was a cultural appropriation that, as most linguistic borrowings are, was slightly inappropriate. The ancient Greek word that it appears to have been borrowed from means “female slave” or “handmaiden” as in “behold the Handmaiden of the lord.”

In 2003, I started a doula training program with another Montreal doula, Lesley Everest. We were already practising doulas, and we were noticing that there was a growing need for doulas in our city. Because of the particulars of maternity care in our area (large, multicultural metropolis, with a struggling infrastructure and poorly paid medical professionals), it was difficult to integrate doulas into the maternity care team. Birth abuse was common, and inexperienced doulas were often traumatized by their experiences. A short weekend workshop about normal birth, and an introduction to the basics of doula care were not enough for these doulas, and they were suffering.

Our course was an intense, comprehensive course that covered almost a full year, and included hours of class work and some shadowing opportunities.

Part of the students’ requirements included fourteen hours of volunteer time. Students started volunteering at the Montreal Diet Dispensary, which provides free food and other resources for mothers in need. They soon realized that these mothers also needed free doula services, and so the students started offering this service. Montreal Birth Companions grew from this small start.

Over the years, the partnership between Lesley and I dissolved, and I concentrated more on the volunteer organization. I was providing free training and mentorship for the volunteer doulas, as well as running a private practice. MBC grew over the years, and now provides doula care for over one hundred clients a year. That’s $100,000 at the average market price for doulas in Canada. I realized that I needed to provide a more comprehensive training for the volunteers, and I could provide MBC with eager, dedicated volunteers through\ the training program.

MBC Doula School grew from this idea. I started with a Level One doula training that provided students with the basics of doula care, enough to give them the skills to accompany a mother through her birth experience together with a partner doula. The Level One training also provided the opportunity for the students to shadow a more experienced doula, until they felt comfortable taking on a client with a partner.

Level Two is the next step, and it is much more comprehensive and gives students the skills they need to provide full care for a birthing mother throughout the childbearing year.

The next step was a natural progression that is in tune with my beliefs about education and knowledge. I provide doula students with much of my own beliefs, philosophies, and approach. They read my book and study for hours under my guidance. I wanted to open up their education by inviting other teachers and guides to provide a different voice, and more varied skills. To this end, I have invited high profile teachers from around the world, and I also invite local guest teachers who are active in the community to share their skills with the school.

I think my general philosophy about life informs my specific beliefs about birth, so I will touch on them briefly. Fundamentally, I do not believe that the particulars that make up our lives can be fully controlled by our desires or actions. As midwives say, meconium happens. However, I do strongly believe that we are responsible for our choices: it is up to us to inform ourselves, make decisions, and then live with the outcomes of those decisions in a conscious and responsible way. How does this reflect on my beliefs about birth? Essentially, I try my best to facilitate an excellent birth experience for a mother and family, and when I am the sole caregiver for that family, I take my responsibility for the safety of the mother and child very seriously. But I do not believe that the ultimate outcome is up to me. The buck does not stop with me. As the Muslims say, pray to Allah, but tie your camel to a tree. So, I interpret that to mean: do all you can, your very best, to ensure a good outcome for mother and baby, but know that all is not 100% in your hands.

Cutting-edge scientific research in the 21^stcentury is focussing more and more on the interconnectedness of things and forces, moving away from a trend that started in the 17^th century which attempted to break down the world around us into easily digestible units.

Unfortunately, modern medicine has not yet jumped into the 21^st century, so we are still burdened with an understanding of the human body that sees it as a collection of pieces that function well together, but are essentially separate. As professional physicians became more a part of our lives in the industrialized world, we also lost the sense of responsibility for our own health care and tend to shift that responsibility and power to our doctors. Add to this precarious mixture a culture that is based on fear, and that uses military metaphors even to sell yogurt (“the best defense”!), and we have a birth culture that is malfunctioning and hurting families. Mothers go into the doctor’s offices afraid of birth, worried that their bodies will not work properly, believing that the doctor knows more than them, and believing without question what the doctor suggests.

My fundamental belief about childbirth is that the human body is perfectly capable, in the vast majority of cases, to give birth to a child without much help, intervention, or trauma. I believe that birth is a physiologic event that is part of the normal function of the female human body. I believe that mothers do not need lessons or techniques to learn how to give birth, but rather, that they often need to be untaught fearful or pathology-based reactions so that the body is allowed to function normally.

I believe that there are ways that a normal birth can be prepared for by the mother and expectant family. These include:

v  Effective prenatal care, including nutritional counselling, a minimum of interventive testing, informed choices throughout the process of pregnancy, labor and birth

v  Prenatal education focusing on physiologic birth, made available for the mother and partner.

v  Community support and resources readily accessible and affordable for all families.

I believe that the control of women’s bodies has been one of the essential characteristics of human life for thousands of years. It may have originated in the disturbing fact that a male could never know exactly who impregnated whom, but that is not important now. The fact that remains, however, is that we live in a culture where the fear of birth and the birthing body is paramount. All over the world, birthing women are abused and violated, usually without their consent. I believe in the value of informed choice, but I am also aware of how the “informer” can bend that information to suit their own political will.

I believe that every single time a birth unfolds without violence, the world and human society is healed a little bit.

My approach to healing and medicine is holistic, in the fundamental sense. I appreciate that most of the tools we see used in maternity care are tools that have appropriate use. While most of them should not be used routinely for every pregnancy or birth, many of them save lives when used in the right way at the right time.

Many birth practitioners make the mistake of assuming that just because something is deemed “natural”, it is fine to use it in any situation with any mother. This is not the case. Neither is it the case that more interventive tools should be used routinely. Midwives and doctors certainly need to use certain tools to monitor a pregnancy and birth. Tape measures are useful in recording the healthy progress of a pregnancy. Hands are immensely useful at all stages of pregnancy, birth and postpartum as diagnostic and healing tools, as are our senses. And of course, there is equipment of all sorts that can and should be used, or at least made available, for every pregnancy and birth.

But we don’t need to use very much equipment or procedures at all if the pregnancy or birth is progressing well and we can see (or hear) the signs of health in the mother and baby.

Education is the most effective tool at our disposal. It is, obviously, what MBC Doula School is all about! But education is much bigger than a doula school. It is every birth story you read on the social media. It’s every conversation you have in the grocery store. It’s the gruelling education that physicians endure in medical school. It’s every one of us, throughout our lives, making choices.

I believe that knowledge is a public resource. It is a vibrant source that changes with each generation, and is constantly being added to and modified. Human knowledge is what makes us human.

As our birthright, it should be shared freely. Those in the business of sharing knowledge and skills, however, need to be paid for their work, and that places knowledge within structures that can be limiting.

Education itself can be limiting, when it is bound by hierarchical, fossilized power structures. Just as the doctor/patient relationship can be one of the powerful and the powerless, so can the teacher/student relationship. When this kind of educational dynamic is established, the student gives up responsibility for active learning and ceases to question, to challenge, and to learn.

MBC Doula School grew out of my thoughts about education and birth. I was teaching a successful three-level doula training. I freely shared everything I knew with my students, for a fee. I gave them practical training and mentorship for free, and for as long as they thought they needed it. I still have former students asking my advice for their clients.

But I am just one voice, one pool of knowledge, one history. There is a whole network, in our city and in the world, of teachers who are eager to share their knowledge and skills, and MBC Doula School is a forum where they can do just that.

MBC Doula School has many students who have gone through the training and then hope to start midwifery education. My advice to them is to attend as many volunteer births as they can. There is always more to learn. It is better if every single birth teaches you something about birth.Many of the MBC Doula School students are still young. Traditionally, midwives have been older, finished with the task of raising small children. I counsel patience to these young doulas. The more births they attend as doulas, the better midwives they will become.

MBC Doula School is the child of Montreal Birth Companions. I have seen that the experience the students gain from their volunteer work with MBC makes them better prepared to enter training for many other professions, from midwifery to medicine to social work, nursing, and more.

Specifically, for students hoping to become midwives, the task of accompanying marginalized families through the childbearing year gives the student exceptionally valuable preparation for a life in midwifery. It prepares them for a life of giving; it teaches them about the medicalization of childbirth; it shows them how to accompany a mother through labor and birth using the lowest technology available (doulas do not use high-tech equipment at all, so they have to rely on their hands, their senses, and some gentle tools); it teaches them humility and cultural sensitivity.

There is a lot of discussion these days about the benefits or ethical meaning of midwives, doulas, and students traveling to poorer countries and gaining experience in birth by providing their services to the families there. There are definitely ethical problems with this model. I believe that student doulas and midwives should look closer to their own communities and focus their volunteer efforts there. There is no need to go elsewhere looking for poor people to practice on. The issue for fully trained midwives is obviously a different one, and every midwife must chose for themselves how they choose to practice. If we start to see that the world is a living, breathing entity, then we will understand that the experiences we need are often just around the corner.

In a more specific sense, the extended family of people surrounding MBC Doula School and Montreal Birth Companions have a strong sense of community, and I strive to nurture that sense. Over the next few months (by June, 2015), we will be teaming up with the Caffe della Pace to provide a physical space where students, doulas, clients, people can meet and share their stories. This community, I am hoping, will be a source of fundamental change in the birth culture in our city and hopefully part of a worldwide movement.

We are now located at the Caffe della Pace, a home for good food, good vibes, and positive change. Please come by and join us!

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.