Montreal Doula Training April 15, 2012

I am happy to announce that I have teamed up with Jana from Studio Vie to organize a doula course that will be starting on April 15, 2012.

The program is based on the approach that I have explored in my book, and we will be using the book as our text.

This program is comprised of three levels. Completion of the Level One course will allow the participants to volunteer as doulas for Montreal Birth Companions volunteer doula organization.

Level Two is a continuation and an exploration of themes introduced in Level One. This level will provide doulas with the necessary skills to run a private doula practice.



 Level Three courses are specialized, and they take place in all sorts of interesting places.

We will be going to Cuba together next spring, and this summer we will be exploring storytelling and healing with Lewis Mehl-Madrona, in Italy.

To be accepted into Level Three you need to have attended births as a doula or lay midwife, and you need a strong foundation in self-directed learning.

If you are interested in accompanying me on any or all of these journeys, please let me know. Our courses are filling up fast!

Ask the Doula - epidurals

I am always getting letters, phone calls, or face-to-face questions about birth, doulas, and such.

Every week, I am going to  try to answer and explore a different question that is presented to me, and, in doing so, perhaps answer some of your questions, and perhaps learn a thing or two myself.

Please send me your questions as comments, and I will select one question each week to answer.



Question Number One

"I was at a birth the other day, and the doctor said to my client that there was a recent study done that proves that an early epidural [that is, administered before 4cm] does not lead to a rise in c-sections. What is your opinion on this?"

I think more doulas and women will start to hear about this study, and I think it reflects a dangerous trend. The doctor who quotes recent research seems very with-it and up-to-date - she's done her homework. But let's have a little look at the research in questions:

The study is a systematic review of six studies that included over 15,000 women. Please click here to retrieve it. As you can see, it is a nice little study, I suppose, with one serious flaw that jumps out on first reading.
It states that the ..."review showed no increased risk of caesarean delivery or instrumental vaginal delivery for women receiving early epidural analgesia at cervical dilatation of 3 [c]m or less in comparison with late epidural analgesia." Early epidural analgesia was defined as that administered at 3 cm or less. Late epidural analgesia was not defined, so it could have been administered anywhere from 4 cm well into the pushing phase. Well, when was it? Was it at 4.5? Or was it after an hour and a half of pushing?

The danger is that, the media being the creature it is, someone could simply snip this conclusion, as I have done, and weave a generalization from it. An unsuspecting woman reads the two-sentence generalization and thinks "ahhh, well, that's a relief, I don't have to wait to take my epidural."

Let's look at the reality:
What do we see, as doulas? As I suggest in my book, IF a baby is not optimally positioned (and, by the way, this is also something that we have studied and studied, and we still can't ever really tell when and if a baby is well-positioned, except by watching her  weave successfully down the birth tunnel), and IF a woman takes an epidural early in her labor, and IF the baby's descent could have been helped by a resistant pelvic floor, then this mother and baby could end up with a surgical delivery.

So, in fact, when I see a nice easy birth and:
a mother who has always taken an epidural (and this is her sixth baby and hey! who am I to argue?)
or a mother who always maintained she would ask for pain meds
or a mother who needs meds for another, outstanding reason (sexual abuse being one - we'll get to that another week)
then I have a better feeling about outcome when she decides to take an epidural (even if I know she doesn't really need it).

But when I see a labor that is not going well, for whatever reason: for example, if a woman is having the particular kind of pain that may indicate a poor position, or a woman is undergoing an induction (more about induction coming up too) that looks like it may fail, then I worry about an early epidural, and its effects on labor.

So what can we do about it? "No, little missy, you cannot take the drugs. I as your doula know best"?
Of course not. Maybe there is not really much we can do in the moment. Maybe prenatal education is absolutely paramount. We need to sit with our clients and talk with them about what they are reading, what they understand, what they believe. We need to work with them and open up to them about our own experiences as doulas, and let them know that although a natural birth is definitely simple, it is not usually easy, and that even during labor they will probably have to make choices. And that her choices WILL affect the way her birth unfolds. If she wants a natural birth in a hospital, she will have to work for it. Part of that work will be not accepting pain medication too early in labor.
I know it goes against the review.
But I have evidence that early epidural administration DOES interfere with the normal progress of labor. That evidence comes from my own observation. No studies, no funding, no university degrees. Just women birthing.

More Storytelling - in Lunigiana

The second installation of our storytelling adventure will be in Lunigiana, a hidden corner of Italy where ancient peoples worshipped the moon and carved moon statues, or "menhir".

Lunigiana Storytelling will take place from July 28 to August 4, 2012. We are inviting anyone who is interested in stories, birth, healing, or just plain relaxing and having fun under the Tuscan moon.

Montreal Birth Companions Volunteer Doula Program

It is with a heavy heart that I have had to put our volunteer efforts on hold for a while. We made an application for funding in January and we are awaiting good news, but in the meantime I have decided I can no longer put in the hours of work I was devoting to the organization.

I was surprised by the lack of response by some of the agencies who have been accepting our volunteer services for many years. Maybe I was kind of imagining people to write back and say that we will all pull together and let's do this thing! But no, the announcement passed without much of a ripple.

Just like the earth, everything needs to be left for a time in order to grow healthy and strong. I am having my fallow time now. I was offered a very good opportunity that meant leaving my family for two months, and I decided to leave that go as well. I need to stay at home, write my book, and let myself be nourished by my surroundings (inside my house, let it be known , not the grey urban landscape outside).

And since I made that decision, all sorts of new sprouts have been poking their green heads up from the ground. To continue my metaphor, even the manure I received from some of the crummier experiences I've had over the years has proven useful. Difficult times and difficult people have taught me to bend when necessary, and to stand firm when possible.

So, please send your best wishes our way, that the powers that be in the funding world smile upon us, so that MBC can continue to provide doulas for the neediest women in our society.

A reader just pointed out - if you wish to donate, please visit the MBC website here and you can donate directly. Thanking you in advance!

March 8, 2012, Festa della Donna

March 8 is International Women's Day, which means a lot of different things to different people. But for me it is a celebration of all that is life-giving and full of energy and love, and a denial of everything that tries to quell that force.

The boy dancing with his mother here was only three years old, years ago in Rome when we went to the airport to pick up our friends who were coming to celebrate the arrival of another baby boy. Mimosa blossoms  were being handed out in the airport, to celebrate the Festa della Donna. Him and his big brother each took a blossom and charged each other the full length of the arrival lounge, turning into knights in shining armor before our eyes.

I was in Cuba last week. The bar across the street from the cut-rate hotel reminded me of many of the bars and beer shacks in Africa, where the prostitutes did a brisk business with the white boys who came to drink, dance to the great sounds of east African music, and have a good time. The women were pretty, lively, and strong.

My mother is eighty-one. She comes to visit us in Italy every year around her birthday. She likes a good laugh, parties, and crowds.

We have a good crew of crones in our family - my great aunts all lived well into their nineties and most of them lived alone because of the Great War. One grew raspberries and kept bees. When I was pregnant with my first, she sent me a huge parcel of red raspberry leaves.

My aunt sailed across the Atlantic in a 21 foot sailboat and smoked a pipe. She was the one who rescued me from my first bottle of scotch when I was fourteen.



 I am honored to have met many, many women over the years who have committed to living life to the fullest. Some of these are my friends, some are my relatives, some I met randomly on a bus, some have been women I worked with. But all of them shared that spirit, that sense that life is not a padded hallway leading to some nice hotel room, but rather a difficult, sometimes dangerous and unexpected journey that leads to who knows where.

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Italy, July 2012?

The studio

We are very excited to present a storytelling and healing workshop with myself, Lewis Mehl-Madrona, Barbara Mainguy and friends that will take place in Umbria, Italy July 2012. It will be a unique retreat in a special place right in the center of the "green heart of Italy". We are inviting anyone who is interested in story, the healing power of narrative, writing, birth, or just plain relaxing and staring at the view.

Please go to Storytelling and Healing for more details.

Birth - The Need for Community

One thing I really enjoyed about the workshop I just led in Halifax was the feeling of community among the women there. Although the participants were mostly doulas, we also had participants from other professions who were just as happy to be there, and who enlivened the activities with their own insights. We ranged in age from just a few weeks old to quite elderly. Some of us work as private doulas, some volunteer, some have a "day job", and doula on the side. It was very refreshing to see such a mixed group of people really connecting and working for a common good - of course, that particular common good being the most women having the best birth experiences.

I had an interesting conversation with a midwife in the group who was discussing program options with an aspiring midwife who now works as a doula. The talk led to the issue of bullying and unkindness within the birth community, and unfortunately it is a real problem that does not go away if it is ignored.

Because birth is so important to us all, and because most of us who work with birth are usually very busy, there seems to be a natural progression to some bad habits. It is so important for all of us to take a good look at ourselves and our beliefs and actions every once in a while. We can see that, for example, we are holding on to a belief about birth that does not apply to every woman. Or that we are being less charitable to those less experienced, by simply criticizing instead of taking time to teach. Or perhaps we feel very strongly about a certain aspect of birth, and hold on to it too dearly.

Attending birth is all about letting go of your own ego and your agenda, and accompanying a woman as she makes her own journey to motherhood. It is also about reaching out to others who are on this path, and being able to accommodate the reality that there are many of us on the path, that we all have different opinions and histories, and that the most important thing is that we walk along together with an attitude of respect.

Not to say that we can't ever disagree. Of course we can. Nothing better than a good argument. But that argument should never, ever take place in a birthing room. It should never descend to personal insults. And if there is no accommodation in sight, no agreement to be reached, then at least we can agree to disagree and continue to work together to provide the very best care for women and their families.