I know so many young women who are eager to spend their time volunteering. They want to gain experience working with women and babies, so they donate hours and bundles of energy to women who perhaps don't have money to pay a doula, or to women who are in a difficult situation postpartum.
This is the core of being a doula, that desire to accompany women on their path toward motherhood, whether we are paid in money or not. I am sure all of us fantasize about an old great grandmother that we have, who traveled from her village to assist women in childbirth, and accepted just a bag of lentils or some corn as payment. This did happen, although I don't think all of our grannies were midwives.
But we have inherited that peaceful, nourishing spirit, and we try our best to assist women, even though lentils cannot pay the rent.
Of course, a midwife has a much greater responsibility than the modern doula. She was responsible for the life of the mother and baby. Often, she was the only one who could save the baby's life - there wasn't an intensive care unit down the road. But she did her job, and she did it well, and the best midwives were the ones who worked in the background of the mother's labor, who assisted only when necessary, who left the honour and joy to the birthing woman.
Just so a doula peaceably attends birth. Not interfering, humble, almost invisible, not a "Professional" or an "Expert", but a friend, a companion. The volunteer doulas who work for Montreal Birth Companions, and other volunteer organizations around the world, are just that - companions. They attend, accompany, and honor the birthing woman. And all for lentils!!
thoughts on running, birth, life, death. Being a woman, having children (or not!), raising a family. Sustainability, farming, cooking food. Business, capitalism, patriarchy and authorities. Anarcho-herbalism, alternative healing, science. Love, peace, life.
Monday, April 11, 2011
Thursday, April 7, 2011
Thank You
I just want to say thank you to all the women who have invited me to attend their births over the past fifteen years. It has been an honor and a pleasure to accompany you through this important time of your life.
And if we only met once when you were in labor, and I rubbed your back but didn't understand your language, thank you. And if I've seen your first child born, and your second, third, fourth, fifth, sixth and seventh, thank you. And if I caught your baby when no one else was around, thank you. And if you gave birth in an hour and a half, thank you. And if I was with you for three days, thank you. And if I held you when you cried, thank you. And if I spoke to you for hours and you birthed in another city, thank you. And if you had a vaginal birth after a surgical one, thank you. And if you had a cesarean to save your baby's life, thank you.
Thank you.
And if we only met once when you were in labor, and I rubbed your back but didn't understand your language, thank you. And if I've seen your first child born, and your second, third, fourth, fifth, sixth and seventh, thank you. And if I caught your baby when no one else was around, thank you. And if you gave birth in an hour and a half, thank you. And if I was with you for three days, thank you. And if I held you when you cried, thank you. And if I spoke to you for hours and you birthed in another city, thank you. And if you had a vaginal birth after a surgical one, thank you. And if you had a cesarean to save your baby's life, thank you.
Thank you.
Monday, April 4, 2011
Loss and Innocence
Last week I got a computer virus. I don't know how it got in - who knows - but it masqueraded as my security system for my laptop. It disabled my firewall, my updates, and my anti-virus protection, and it tried to persuade me to go to its site and pay for new software. It mimicked the Microsoft site very well, and the only way I recognized it was because of a small spelling mistake. I was the frizzy-haired girl with crooked teeth who excelled at spelling bees. You can guess how popular that made me!
I digress.
The other thing that happened - the thing I can hardly think about, let alone talk about or analyze - is that I heard about a good friend whose son's favorite teacher was arrested for pedophile acts.
He went in, disabled the firewall, and the virus protection, and took advantage of his student's innocence to fulfill his twisted needs. The children that were better educated about boundaries resisted his approaches, but all of them were propositioned: this blog is not about how we need to teach our children (we do). It's about how trust can be horrifically betrayed.
The most important thing I have been told about this type of situation is that when it happens, no matter how much the parent would like to believe that the child will forget about it, it is very important that it is dealt with immediately, by talking, understanding, affirming the damage done, and learning about prevention.
The same goes for a traumatic birth experience. When a woman has trusted her doctor, and listened to his or her assurances that she or he is supportive of natural birth, and then gets to the hospital in labor and realizes that she made the wrong choice, and then pays dearly for that choice, it is important for her to have a place to go where she can heal, where she can talk honestly about what happened. It may not be right away, and usually isn't, because she is, after all, a new mother and usually she is experiencing a baby-moon phase. But it will come up, and it is often the doula or midwife who is present for her next pregnancy and birth experience who will be the person she can trust to be non-judgmental and will help her to get to a place of forgiveness and love. Where we can get the healing done.
I digress.
The other thing that happened - the thing I can hardly think about, let alone talk about or analyze - is that I heard about a good friend whose son's favorite teacher was arrested for pedophile acts.
He went in, disabled the firewall, and the virus protection, and took advantage of his student's innocence to fulfill his twisted needs. The children that were better educated about boundaries resisted his approaches, but all of them were propositioned: this blog is not about how we need to teach our children (we do). It's about how trust can be horrifically betrayed.
The most important thing I have been told about this type of situation is that when it happens, no matter how much the parent would like to believe that the child will forget about it, it is very important that it is dealt with immediately, by talking, understanding, affirming the damage done, and learning about prevention.
The same goes for a traumatic birth experience. When a woman has trusted her doctor, and listened to his or her assurances that she or he is supportive of natural birth, and then gets to the hospital in labor and realizes that she made the wrong choice, and then pays dearly for that choice, it is important for her to have a place to go where she can heal, where she can talk honestly about what happened. It may not be right away, and usually isn't, because she is, after all, a new mother and usually she is experiencing a baby-moon phase. But it will come up, and it is often the doula or midwife who is present for her next pregnancy and birth experience who will be the person she can trust to be non-judgmental and will help her to get to a place of forgiveness and love. Where we can get the healing done.
Friday, April 1, 2011
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.
"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.
Thursday, March 31, 2011
Owning Our Practice
When we are working with such an elemental and mysterious thing as birth, it is often hard to tell where the lines that define ourselves and others can or should be drawn. I was speaking with another very experienced doula the other day who took exception to something I said. I suggested that inexperienced doulas may not be as successful at preventing unnecessary cesareans as a doula who has had years of experience working in a hospital environment with many diverse clients.
She countered, and rightly so, that the essential role of the doula is to offer companionship and respect, and those qualities will triumph, whatever the outcome.
I agree. To a point. Love works wonders. But a combination of things are at play, especially in a busy hospital that may or may not have a sensible approach to natural birth. A younger, less experienced doula may not know quite how to respond when a resident reaches for the amniotomy hook as she is doing a vaginal exam and prepares to do an amniotomy, all without saying anything to the laboring woman. Although we don't like to admit it, it is true that even the presence of a more experienced doula will help doctors to exercise caution. A less experienced doula will not know the policies and protocols of the various hospitals as well as a more experienced one. She will not have built relationships with the medical staff she is working alongside. All these elements can and sometimes do lead to the inexperienced doula accompanying a woman along a very different path than the one they had hoped.
That said, is that not our ultimate mandate? To accompany? To be a companion as the woman makes her journey? If we are beside a woman and her partner as they are becoming parents, and we are there to support, to love and respect, as the woman moves through labor, is that not sufficient?
Yes, if the environment she is birthing in is a sane and healthy one. Definitely. But what if a woman is birthing in an environment where the professionals are overworked, the infrastructure is crumbling, the focus is on risk instead of health, statistics are distributed as freely as narcotics, and the emotional and spiritual side of bringing a child into this world are more or less ignored? Then, possibly, a birthing woman needs more than a companion in love. She needs a watcher, a guardian. Experience, skill, humility, and an open heart are the foundation blocks that a doula can build her practice upon. And one important rule is: never stop learning. When you have a chance to change your mind, change it. When you feel you know enough, know you are wrong. The responsibility is great, the stakes are high. Ego should not take part in the miracle of birth.
She countered, and rightly so, that the essential role of the doula is to offer companionship and respect, and those qualities will triumph, whatever the outcome.
I agree. To a point. Love works wonders. But a combination of things are at play, especially in a busy hospital that may or may not have a sensible approach to natural birth. A younger, less experienced doula may not know quite how to respond when a resident reaches for the amniotomy hook as she is doing a vaginal exam and prepares to do an amniotomy, all without saying anything to the laboring woman. Although we don't like to admit it, it is true that even the presence of a more experienced doula will help doctors to exercise caution. A less experienced doula will not know the policies and protocols of the various hospitals as well as a more experienced one. She will not have built relationships with the medical staff she is working alongside. All these elements can and sometimes do lead to the inexperienced doula accompanying a woman along a very different path than the one they had hoped.
That said, is that not our ultimate mandate? To accompany? To be a companion as the woman makes her journey? If we are beside a woman and her partner as they are becoming parents, and we are there to support, to love and respect, as the woman moves through labor, is that not sufficient?
Yes, if the environment she is birthing in is a sane and healthy one. Definitely. But what if a woman is birthing in an environment where the professionals are overworked, the infrastructure is crumbling, the focus is on risk instead of health, statistics are distributed as freely as narcotics, and the emotional and spiritual side of bringing a child into this world are more or less ignored? Then, possibly, a birthing woman needs more than a companion in love. She needs a watcher, a guardian. Experience, skill, humility, and an open heart are the foundation blocks that a doula can build her practice upon. And one important rule is: never stop learning. When you have a chance to change your mind, change it. When you feel you know enough, know you are wrong. The responsibility is great, the stakes are high. Ego should not take part in the miracle of birth.
Monday, March 28, 2011
Natural Birth
Here in Montreal, a woman has a few choices when it comes to giving birth:
We have several large hospitals, most of which have maternity centers. If you are birthing in a hospital, you will be followed either by a family physician or by an obstetrician. Because doctors here in Montreal get paid less, are more overworked, and have to work under worse conditions than in the rest of the country, there is a real problem of access and availability. This means that a woman may not find a doctor who necessarily agrees with her approach to childbirth. The larger hospitals are also teaching units, so women in labor are under the care of several people other than the doctor she is officially being followed by.
There are three midwife-run birthing centers in Montreal. Two of these offer women a choice to birth either at the center or at home. The third provides home-birth midwives to eligible women. Demand for these provincially registered midwives is high, and the eligibility requirements are strict.
There are women in Montreal who do not want to follow the provincial rules, and these women have two choices. Some hire "lay midwives", who have been trained elsewhere and are not registered with the Quebec college. Still others give birth on their own or with their partner or a friend.
For years I was getting swamped with requests from women who were desperate about their chance of having a natural birth. The conversation would go something like this:
"I was on the waiting list for the Birthing Center but I know I have a very slim chance. So I've decided to go with Doctor x at y hospital, because I have heard they have a more natural approach. I would like to give birth at home with a midwife but I do not feel comfortable with an unassisted childbirth, and my husband is not happy about hiring a lay midwife. So we feel our best choice is to hire a doula."
Yes, the presence of a doula can reduce interventions. Yes, my c-section statistics (6%) compare well with most of the Montreal hospitals' statistics (25-30%). Yes, birth can take unexpected turns and you are well advised to have a trained attendant. But to be able to stay in your own bed after giving birth, and bring your child into an environment that is your own means a great deal not only to the mother, but also to the newborn.
And my concern is, I am not getting those phone calls any more. The calls are still about hiring a doula, but they are usually not from women who are serious about natural birth. The women who are on the midwives' waiting lists are actually getting in to the birthing centers. They are not hiring lay midwives, and they are not giving birth unassisted. I know that the birthing centers are not working at over capacity; they have rules about how many they can take on. So my conclusion can only be that the desire for a midwife-assisted birth is becoming more rare, and this makes me wonder. Is the doula-accompanied birth in the hospital the way of the future?
We have several large hospitals, most of which have maternity centers. If you are birthing in a hospital, you will be followed either by a family physician or by an obstetrician. Because doctors here in Montreal get paid less, are more overworked, and have to work under worse conditions than in the rest of the country, there is a real problem of access and availability. This means that a woman may not find a doctor who necessarily agrees with her approach to childbirth. The larger hospitals are also teaching units, so women in labor are under the care of several people other than the doctor she is officially being followed by.
There are three midwife-run birthing centers in Montreal. Two of these offer women a choice to birth either at the center or at home. The third provides home-birth midwives to eligible women. Demand for these provincially registered midwives is high, and the eligibility requirements are strict.
There are women in Montreal who do not want to follow the provincial rules, and these women have two choices. Some hire "lay midwives", who have been trained elsewhere and are not registered with the Quebec college. Still others give birth on their own or with their partner or a friend.
For years I was getting swamped with requests from women who were desperate about their chance of having a natural birth. The conversation would go something like this:
"I was on the waiting list for the Birthing Center but I know I have a very slim chance. So I've decided to go with Doctor x at y hospital, because I have heard they have a more natural approach. I would like to give birth at home with a midwife but I do not feel comfortable with an unassisted childbirth, and my husband is not happy about hiring a lay midwife. So we feel our best choice is to hire a doula."
Yes, the presence of a doula can reduce interventions. Yes, my c-section statistics (6%) compare well with most of the Montreal hospitals' statistics (25-30%). Yes, birth can take unexpected turns and you are well advised to have a trained attendant. But to be able to stay in your own bed after giving birth, and bring your child into an environment that is your own means a great deal not only to the mother, but also to the newborn.
And my concern is, I am not getting those phone calls any more. The calls are still about hiring a doula, but they are usually not from women who are serious about natural birth. The women who are on the midwives' waiting lists are actually getting in to the birthing centers. They are not hiring lay midwives, and they are not giving birth unassisted. I know that the birthing centers are not working at over capacity; they have rules about how many they can take on. So my conclusion can only be that the desire for a midwife-assisted birth is becoming more rare, and this makes me wonder. Is the doula-accompanied birth in the hospital the way of the future?
Thursday, March 24, 2011
A Peek into the Doula's Year
… you are assisting at someone else’s birth. Do good without show or fuss. Facilitate what is happening rather than what you think ought to be happening. If you must take the lead, lead so that the mother is helped, yet still free and in charge. When the baby is born, the mother will rightly say: “We did it ourselves.” Tao Te Ching
January 23 … I make myself comfortable on the couch in the living room … they have the lights on low and there is a sweaty, earthy smell in the air. The cat hovers around my ankles. I hear another contraction coming and going. Its 3 a.m. and I have been here for two hours. In the morning, we will go to the hospital, driving on the highway at dawn. The baby will be born by breakfast time. Everything is good.
March 16 … I am sitting in the Jacuzzi room, kneeling quietly next to the bath as I splash water on her back.
July 3 … She wants to dance during contractions, back and forth across the small room, keeping me moving as she holds my hands.
October 1 … I speak gently to the father-to-be, explaining that her pain is normal and his anxiety is perfectly natural.
December 23 … She calls me at home at 2 a.m. I awaken and answer the phone quietly. She says she is in labor and wants me to come to her. I hear from her voice that she is not ready so I speak to her for a while through a few contractions and suggest that she tries to sleep. She calls me at 7 a.m., after sleeping for four hours. She was woken by stronger contractions and she calls me to find out if it is time to go to the hospital. I reassure her that she is coping very well and I talk her through a couple of contractions over the phone. As she is still able to talk through them, I know that I will be able to start my day as planned. She calls me after lunch to say that she has lost a pinkish mucus plug and that she can no longer speak through contractions. I reassure her that everything is going well. At 9 p.m. her husband calls and I can hear her moaning in the background: they want me to meet them at the hospital. We arrive together and the doctor finds her cervix is seven centimeters dilated. She is given a room and she continues to labor well. Her back is hurting and I use St John’s Wort oil to relieve the pain. Her husband is by her side, letting her know that she is doing a great job. She turns to me and says that she needs pain relief. I tell her that this intensity of pain probably means that the baby is almost here. With her next contraction she starts to push. The nurse comes into the room and notices that she is pushing and calls the doctor. As the doctor arrives, it is clear that the lady is pushing and her baby will be born soon. The doctor greets her patient and as the nurse prepares everything on the delivery cart, there is silence and peace as the woman relaxes in between her contractions. As she gets ready to push again, her husband gently wipes her face as he murmurs words of encouragement. I know that with this contraction, the baby will be born. And he is. The doctor tells her patient to reach down to take her child; as she does, her husband bursts into tears. The nurse helps her to place the baby on her chest and covers them both with a warm blanket. I look at the doctor and we smile at each other, happy with the team effort.
January 23 … I make myself comfortable on the couch in the living room … they have the lights on low and there is a sweaty, earthy smell in the air. The cat hovers around my ankles. I hear another contraction coming and going. Its 3 a.m. and I have been here for two hours. In the morning, we will go to the hospital, driving on the highway at dawn. The baby will be born by breakfast time. Everything is good.
March 16 … I am sitting in the Jacuzzi room, kneeling quietly next to the bath as I splash water on her back.
July 3 … She wants to dance during contractions, back and forth across the small room, keeping me moving as she holds my hands.
October 1 … I speak gently to the father-to-be, explaining that her pain is normal and his anxiety is perfectly natural.
December 23 … She calls me at home at 2 a.m. I awaken and answer the phone quietly. She says she is in labor and wants me to come to her. I hear from her voice that she is not ready so I speak to her for a while through a few contractions and suggest that she tries to sleep. She calls me at 7 a.m., after sleeping for four hours. She was woken by stronger contractions and she calls me to find out if it is time to go to the hospital. I reassure her that she is coping very well and I talk her through a couple of contractions over the phone. As she is still able to talk through them, I know that I will be able to start my day as planned. She calls me after lunch to say that she has lost a pinkish mucus plug and that she can no longer speak through contractions. I reassure her that everything is going well. At 9 p.m. her husband calls and I can hear her moaning in the background: they want me to meet them at the hospital. We arrive together and the doctor finds her cervix is seven centimeters dilated. She is given a room and she continues to labor well. Her back is hurting and I use St John’s Wort oil to relieve the pain. Her husband is by her side, letting her know that she is doing a great job. She turns to me and says that she needs pain relief. I tell her that this intensity of pain probably means that the baby is almost here. With her next contraction she starts to push. The nurse comes into the room and notices that she is pushing and calls the doctor. As the doctor arrives, it is clear that the lady is pushing and her baby will be born soon. The doctor greets her patient and as the nurse prepares everything on the delivery cart, there is silence and peace as the woman relaxes in between her contractions. As she gets ready to push again, her husband gently wipes her face as he murmurs words of encouragement. I know that with this contraction, the baby will be born. And he is. The doctor tells her patient to reach down to take her child; as she does, her husband bursts into tears. The nurse helps her to place the baby on her chest and covers them both with a warm blanket. I look at the doctor and we smile at each other, happy with the team effort.
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