I am actually enraged this morning, and I have been since last night. It's just no good any more to pretend to be kind old Mrs Tiggy Winkle, and watch women being abused over, and over, and over again in our worn out medical system.
A few weeks ago, I witnessed a natural, speedy delivery. The woman was effectively pushing in a supported squat. Enter the doctor, who cannot catch a baby from underneath and pressures the woman to lie down. A small shoulder dystocia develops. Doc pulls on the head like there's no tomorrow and breaks the baby's collar bone.
That same week, a foreign lady let me know that an OB at the same hospital has been charging her $100 cash for each prenatal. Here in Canada, that is ILLEGAL.
She labors beautifully, and is almost delivering, when the doc suggests an episiotomy. This was the one thing, the ONE THING, that my client was terrified of. Luckily, she pushed the baby out with the next contraction.
Move forward, random thoughts: A client was in the hospital for twelve hours. During that time, she saw about ten medical professionals. What do you think the most-asked question was: How are you feeling? Nope. "Do you have any questions?" Nope. "Is there anything you need?" Nope. It was "Have you had any miscarriages or abortions. Well, it's not rocket science to figure out that that may not be the best question to ask a laboring woman for two reason: One, she may not want everyone in the room, including her partner, to know. And, Two, these are painful memories that she may not want to think about.
But yesterday takes the cake.
Lady is being induced, medically necessary induction. Gets put on the pit. She's 2 cm. Then in five hours, she's seven cm! And then two hours later, still seven cm! They are talking AROM, so my client wants me to come to the hospital. Fine.
She's laboring so well, not feeling her contractions at all. I have seen this, infrequently, but I've seen it. The doc wants to AROM, but since she's seven cm, she decides to wait it out.
Finally, in the evening, another physician comes in and checks her. She's two.
Discussion. Justification "your vagina is a funny shape". "She's a good resident so we don't check her results". Even when those results are difficult to believe? Really? Then, a peace offering. You stay here and sleep, we'll start the induction again tomorrow.
Bad Science: why the induction? check your results, and especially check a student's results. Have a look at how you're playing with the insulin and oxytocin.
Bad Bedside manner: Is it necessary that a woman not eat for days? Is it possible to at least make eye contact with the doula, so that she doesn't feel like shit when she leaves the hospital? Are you going to apologize for your mistakes?
Bad Luck: How often do iatrogenic errors lead to major consequences?
Where is this all leading? It's not leading to a rise in home births, at least not in Quebec. I was speaking to a midwife yesterday from another country who has witnessed over a thousand births, and she is not certified here and therefore is not practicing. There is no bridging program that effectively allows for CPMs to become certified here in Canada, so we are left with a lack of midwives and an overburdened hospital system where errors frequently can and do happen.
Comments? What are YOU doing to change obstetrical care in your community?
Friday, November 16, 2012
Tuesday, November 6, 2012
Thoughts on Solitude
We are all alone. We are born alone, and we die alone. This little albino lizard blends in so well with her surroundings, we can hardly even see her against the whiteness of the sand. But she is alone, just like you and me.
The most wonderful and valuable service a doula can offer another woman during her childbearing year is companionship.
The newborn is the most beautiful, alluring little creature. But he needs attention, breastmilk, love, concern...he is alone too, but he knows what he wants. He wants to be held, nuzzled, nursed, touched, loved.
Please be mindful when you are accompanying a woman on the journey of giving birth to a new life. Be mindful if you are accompanying her on a more difficult journey, when she is not having a perfect experience. Please be mindful when you are feeling alone, and remember that the air you breathe in has just been breathed out by another person. Please be mindful when you speak to a woman in labor. Be mindful when you stand next to an old woman on the bus. Be aware that your presence can mean a universe to a woman who is feeling alone.
Monday, October 29, 2012
Radical Doulas
One of "my" doulas was at a clinic the other day and she met a resident who apparently had worked with me in a hospital birthing room some months ago. The resident made two comments about me: "Rivka doesn't like me because I'm a man". And "she concentrates on the woman - we are just there as technicians to catch the baby".
Funny, I like men generally. I wonder if he could think a little deeper about why I may have given him the cold shoulder. Was he treating my client with disrespect? Was he reading the situation closely? Did he have the woman's best interests at heart? Was he acting according to protocol, to science, or to "ghost protocols" (those ones that get left over at hospitals because they are too hard to change)? Was he working from his heart? Did he ask my client to lie down when she was pushing perfectly well in a squat? Was he scared?
And "she concentrates on the woman". Well, hello, that is what a doula is supposed to do. We are not there to make friends with the medical staff. I have very cordial relations with many of the nurses and physicians I work with. But I do not go into a hospital to make friends. I go into a hospital to provide my client with a safe place to give birth. That means that I make every effort to create a peaceful environment in which the woman can let go and do her work of birthing. I don't have to joke and laugh with residents. I can quietly whisper to the woman so that she is feeling good. I'm not interested in staring at her vulva as it opens. I've seen it lots of times, it is doing perfectly well, and there is no medical need for me to do so.
If a woman is undergoing an intervention that I do not approve of, then I will definitely put my back to the staff and direct all my love and attention to the woman. Women DO undergo unnecessary interventions in the hospital, far too often. I am not talking about women who go into the hospital with a clear plan to be induced, have an epidural, and be happy. I am talking about the HUGE number of women who actually believe they can give birth naturally in the hospital environment.
These women are often treated badly by under-experienced residents. If a woman has a small leak of amniotic fluid, that's no reason to admit her to the hospital two weeks before her EDD and then break her waters twelve hours later to stimulate labor. If a woman is happily pushing in a supported squat, there is no reason why she should lie down just because the doctor hasn't caught a baby that way. If I see a resident reaching for the amnihook, with his hand in a woman's body, I will say something. That something might be said in a gentle voice, but it probably won't be friendly. And the woman on the bed will appreciate my interference. I am not against a justified AROM. But you never insert something in a woman's vagina without telling her what you're planning on doing.
Do you?
Radical doulas, we need to stand up and speak out. Women are being treated badly in our hospitals and I am ready to take a stand.
I am taking notes of occasions where my clients have been abused during labor and childbirth. Please start to take notes too and we will start to create a manifesto.
Power to the birthing woman!
Funny, I like men generally. I wonder if he could think a little deeper about why I may have given him the cold shoulder. Was he treating my client with disrespect? Was he reading the situation closely? Did he have the woman's best interests at heart? Was he acting according to protocol, to science, or to "ghost protocols" (those ones that get left over at hospitals because they are too hard to change)? Was he working from his heart? Did he ask my client to lie down when she was pushing perfectly well in a squat? Was he scared?
And "she concentrates on the woman". Well, hello, that is what a doula is supposed to do. We are not there to make friends with the medical staff. I have very cordial relations with many of the nurses and physicians I work with. But I do not go into a hospital to make friends. I go into a hospital to provide my client with a safe place to give birth. That means that I make every effort to create a peaceful environment in which the woman can let go and do her work of birthing. I don't have to joke and laugh with residents. I can quietly whisper to the woman so that she is feeling good. I'm not interested in staring at her vulva as it opens. I've seen it lots of times, it is doing perfectly well, and there is no medical need for me to do so.
If a woman is undergoing an intervention that I do not approve of, then I will definitely put my back to the staff and direct all my love and attention to the woman. Women DO undergo unnecessary interventions in the hospital, far too often. I am not talking about women who go into the hospital with a clear plan to be induced, have an epidural, and be happy. I am talking about the HUGE number of women who actually believe they can give birth naturally in the hospital environment.
These women are often treated badly by under-experienced residents. If a woman has a small leak of amniotic fluid, that's no reason to admit her to the hospital two weeks before her EDD and then break her waters twelve hours later to stimulate labor. If a woman is happily pushing in a supported squat, there is no reason why she should lie down just because the doctor hasn't caught a baby that way. If I see a resident reaching for the amnihook, with his hand in a woman's body, I will say something. That something might be said in a gentle voice, but it probably won't be friendly. And the woman on the bed will appreciate my interference. I am not against a justified AROM. But you never insert something in a woman's vagina without telling her what you're planning on doing.
Do you?
Radical doulas, we need to stand up and speak out. Women are being treated badly in our hospitals and I am ready to take a stand.
I am taking notes of occasions where my clients have been abused during labor and childbirth. Please start to take notes too and we will start to create a manifesto.
Power to the birthing woman!
Wednesday, October 24, 2012
Montreal Birth Companions Radical Doulas
I am writing today mainly to praise and glorify! The radical, wonderful volunteer doulas who work alongside me in Montreal Birth Companions.
This month we are working with about ten women, from varied places across the globe, from China, Quebec, the Ukraine, the middle east and the Caribbean. I have each of these ladies assigned to two doulas, that's twenty doulas and many, many woman hours, and all of those hours are taken away from time spent at jobs, with family, or at other activities.
Some of the volunteers are doulas who are taking my doula course, but others are fully qualified doulas who still commit time to volunteering for this worthy cause.
MBC volunteers, you are amazing radical doulas. I love you all.
Friday, October 19, 2012
Birth and Beyond 2012
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| Birth and Beyond 2012 Having my AM coffee |
I had such a lovely train ride to London, Ontario. I like riding the slow train, and the Ontario coutryside is beautiful, and I enjoyed hearing the announcements in good English and lousy French (petty but true).
But I only took the train because I was scared to fly - so much unexpected stuff had happened in my life - in Italy the car was totalled, no details available, involved a 20 year old offspring (mine). But we were in Bali at the time so we got that text you never want to get: "covered with blood car totalled please call".
Then my father died.
So I had a crazy solo trip from up on top of my mountain, which is a place of peace and air and refuge.
Down the mountain in the ramshackle little Fiat. Train to Florence, then Rome, on the plane. Sitting next to a lovely young couple who had just spent their week vacation in Rome - they were in love! And it's good they were sitting next to a birth attendant, because I don't think any old middle-aged woman would have been so comfortable with their seriously heavy petting!
I spent time with my family, trying to figure out how to properly say goodbye to an atheist scientist. We did a good job, and we all felt very lonely by the end....then it was the Jewish high holidays, they are called high because they are the most important festivals of the year, a time of introspection, taking stock, making peace with one another. I got back to my house in Montreal and discovered that my former partner is ill. Then a lovely volunteer I worked with in Bali passed away unexpectedly...
It was in the middle of the holidays that I had a wonderful opportunity to speak at the Birth and Beyond Conference. The conference was great - it was the first annual and for a new project it was very well attended. I am really looking forward to next year! We had the opportunity to listen to, and interact with, many wonderful people in the birth world including James McKenna, Robbie Davis-Floyd, Jodi Hall, and many others. The intimacy of the conference was lovely - everyone mingled and branched out. There was a wonderful art exhibition as well, and a drumming circle...please register for next year so that I can meet up with you all!
Upon my return, my husband's heart decided to act up. Not for lack of love. He is still in love, and gets love in return from me and my five sons. He is very active, eats well, is young (five years younger than me, anyway!). But his genes didn't tell him that he had some issues, and boom!
We are ok now, and thinking about some changes in our lives...
I posted a status update on my birthday this year - August 21, my father died on the 19th. I asked you all to give your loved ones some loving. Do it now.
Thursday, October 11, 2012
Fall 2012
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| Autumn Leaves |
So much has happened since the summer months - its hard to imagine that it's only been four months since I was preparing for my trip to Bali.
Yayasan Bumi Sehat is one of the most beautiful places on earth. Please have a look at their website, and make a donation if you can. I will be holding a fundraiser here in Montreal in the near future, and I plan to blog more about my experiences there over the next few months. In short, Bali is a wonderful place, and the Bumi Sehat clinic is next to its heart.
After my too-short stay in Bali, we traveled up to our hideaway in Italy, where we are slowly fixing up a pile of rocks we call our sometimes home. Our place on the mountain started as a family project, on an isolated track off the beaten path in the mountains of Italy. Families grow and change, but the building, clearing, hiking and mushrooming stays the same. This past summer, we had a lot of work to do to repair the damage done by 2011's harsh winter. We finally got it all fixed up and we settled in to relax a little...
Back in Canada, several family events led me to realize that we are being invited, when we come into this reality, to take part in a magical mystery tour. The most important thing is to be kind to the ones around you. Show the people you love that you love them, each and every day. Don't take anything for granted. Thank you, I love you, and I'm sorry are important phrases. Don't forget to use them.
More exciting news for the fall: Levels One and Two of the Birth Companions Doula Course are starting this weekend at Studio Vie. Visit my site and have a look at what's offered.
I am taking on more doula clients for the fall, as well as guiding women through the maze of birthing choices here in the city. I am always struggling to keep our wonderful volunteer organization afloat - if you are feeling generous and want to contribute to this very worthy cause, please visit Montreal Birth Companions.
Advice for 2012?
Be gentle with others. That includes birthing women and newborns.
Love each other.
Thursday, September 20, 2012
Birth is Political
Like everything else. Birth is political.
I am on the train right now going through lovely Ontario, on my way to a conference. I will be presenting two workshops tomorrow. One is for birth attendants, exploring the ways we can assist women to have natural births in the hospital setting. One is for anyone who is interested in setting up and maintaining a volunteer doula program, on zero funding (Montreal Birth Companions has been going for close to ten years now, and we have assisted up to 100 women a year).
The conference has been the subject of some controversy because of one of the speakers. Emotions and opinions are strong and heated. Everyone believes they know best. Best for the woman, best for her baby, her family, and the world at large.
I, too, believe that my opinions count. I believe women's bodies are made to give birth, that most women can retrieve their physical knowledge of how to birth, and that if well nourished women are given the right kind of care and a safe space in which to do it, they can usually give birth to healthy babies without much problem. I believe the physiologic need for surgical intervention should probably hover around 2 to 5 per cent, for women who have had good prenatal care. Our present rate of 25 to 30 per cent is a crying shame.
But I also know that my opinions are hotly argued against by others who consider themselves more educated, more scientific, and more knowledgeable.They may even consider my opinions to be dangerous. Or, indeed, inconsequential.
Most of my activities don't rock any boat. When I sit quietly in a hospital room and surround a laboring woman with love, and watch closely as the doctor, acting in good faith and confidence, persuades her to take an unnecessary epidural, or a needless induction, I am being a good citizen.
When I coordinate a volunteer doula for a refugee from Somalia who has been circumcised, and who wants to have a natural birth, I am just rocking the boat gently enough that the passengers will feel comfy and slightly sleepy.
When I suggest to a woman who has not been able to obtain a registered midwife, and who doesn't want to give birth in a hospital, no matter how friendly it may be, that she look around for an unregistered, "illegal" midwife, then I am starting to make some small waves, but still not even good enough for decent boogie-boarding.
Let's try to sail together into the future, taking the waves as they come, breathing together...
Oh! my metaphor is hitting shoals - of course - who is the captain? The right answer is: the captain of the Birth Boat is the woman who is laboring and giving birth. She is the one we are attending. We are the ones with the knowledge and we can use it wisely and quietly, without scaring her as she works at bringing her baby into the world.
The root of "radical" is "root". We are trying to discover the root of the problem, we would like to root it out, to make a fresh start in the world of birth, and in the world.
Come visit me at the Radical Doula site:
Rivka
I am on the train right now going through lovely Ontario, on my way to a conference. I will be presenting two workshops tomorrow. One is for birth attendants, exploring the ways we can assist women to have natural births in the hospital setting. One is for anyone who is interested in setting up and maintaining a volunteer doula program, on zero funding (Montreal Birth Companions has been going for close to ten years now, and we have assisted up to 100 women a year).
The conference has been the subject of some controversy because of one of the speakers. Emotions and opinions are strong and heated. Everyone believes they know best. Best for the woman, best for her baby, her family, and the world at large.
I, too, believe that my opinions count. I believe women's bodies are made to give birth, that most women can retrieve their physical knowledge of how to birth, and that if well nourished women are given the right kind of care and a safe space in which to do it, they can usually give birth to healthy babies without much problem. I believe the physiologic need for surgical intervention should probably hover around 2 to 5 per cent, for women who have had good prenatal care. Our present rate of 25 to 30 per cent is a crying shame.
But I also know that my opinions are hotly argued against by others who consider themselves more educated, more scientific, and more knowledgeable.They may even consider my opinions to be dangerous. Or, indeed, inconsequential.
Most of my activities don't rock any boat. When I sit quietly in a hospital room and surround a laboring woman with love, and watch closely as the doctor, acting in good faith and confidence, persuades her to take an unnecessary epidural, or a needless induction, I am being a good citizen.
When I coordinate a volunteer doula for a refugee from Somalia who has been circumcised, and who wants to have a natural birth, I am just rocking the boat gently enough that the passengers will feel comfy and slightly sleepy.
When I suggest to a woman who has not been able to obtain a registered midwife, and who doesn't want to give birth in a hospital, no matter how friendly it may be, that she look around for an unregistered, "illegal" midwife, then I am starting to make some small waves, but still not even good enough for decent boogie-boarding.
Let's try to sail together into the future, taking the waves as they come, breathing together...
Oh! my metaphor is hitting shoals - of course - who is the captain? The right answer is: the captain of the Birth Boat is the woman who is laboring and giving birth. She is the one we are attending. We are the ones with the knowledge and we can use it wisely and quietly, without scaring her as she works at bringing her baby into the world.
The root of "radical" is "root". We are trying to discover the root of the problem, we would like to root it out, to make a fresh start in the world of birth, and in the world.
Come visit me at the Radical Doula site:
Rivka
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