Freedom For Birth (Web version)

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The Power of Love

My husband suddenly said to me the other night, "Remember when you were in labor and you asked the midwife if she thought you could birth vaginally"?
I though back to that afternoon. I was working hard at a VBAC. I was in the birth pool, and fast approaching a milestone in my labor.
"No, I don't remember that. What did she say?"
My husband looked at me. "She said, "No." Just like that. No."

"Well", I said, "that's where I learned midwifery. That's where I learned what NOT to say. That birth and many, many other births where I have been the witness of what NOT to do or say to or with a birthing woman."

Last week we went for a run together. He had a heart attack two months ago and you could not imagine a less likely person to have one ... fit, energetic, athletic, and all that ... anyway it happened, so he is slowly getting back into his exercise routine. He was wearing a heart rate monitor. I was running next to him and he couldn't get his heart beat lower than 140, unless he slowed to a walk. I ran ahead. His heart rate slowed down. I ran back to be next to him. His heart rate speeded up.

I ran a few blocks ahead of him the whole way and he kept his heart rate level. That means ... like the Kinks song - "you make my heart sing..." which is nice, after thirty years.




But it also means, as described so beautifully in the Secret Teachings of Plants, that the heart itself produces messages and hormones that we still do not understand.


And that's where the presence of a doula makes such a difference to the birthing woman. Because she understands that there are reasons for and reasons why that we cannot understand. She sees that most of the time - not all, but most - the body, mind and soul work perfectly well together - or as perfectly as we are used to, which ends up being that raggle-taggle, patched together, immensely beautiful way we call being alive. She sees that a woman who is left alone, within a bubble of her own labor, surrounded by people who love her - and this does not exclude the attending physician, if that is what she desires - will bring forth a child in her own sweet time, using whatever means we understand or do not understand.


And that is also why we have to be so careful when we are attending a birthing woman. Careful with our words, with our bodies, with our thoughts and emotions. Because who knows how sensitive she is to the slightest nuance? And who know how your own heart is acting? What are you communicating to the birthing woman under the surface of your public presence?

Breathe Together

I have had some feedback about the title of my book. Several reviewers have given it "five stars", but have had doubts about reading it because they thought it would be an angry, polemical work about the horror of hospitals and the saintliness of doulas.

And it isn't.

I have a holistic world view, which means that I believe that there is a place for most types of activities and interventions, within very strict limitations. A 90% epidural rate for first-time mothers is just plain wrong. 90% of all first time mothers do not want an epidural, although certainly some do. And very few first-time mothers actually need pain medication. If and when they do, an epidural is a very effective tool that can provide exactly what the doctor ordered.

Cesarean sections are also very, very useful tools. Surgery can save a baby's or a mother's life. But one quarter of mothers and babies in North America are not in danger of dying during childbirth, adn so we see that this tool as well is overused.

We have come to believe that the overuse of these tools is necessary. Women are afraid of pain, men are afraid of birth, and children are being born into bright lights, machines, masked humans, and a mother nowhere in sight.

Here is a little explanation of my use of the word "conspiracy":

The root of “conspiracy” comes from the Latin conspirare, from con- “together with” and -spirare “breathe.” My hope is that just as women instinctively know how to breathe through their contractions, we will realize that we all know how to breathe together. Whether we are in a hospital, a birthing center, or at home, when all of us: physicians, nurses, midwives, obstetricians, doulas, birthing women, partners and, of course, the baby, are working as one in the birthing room, then the birth experience will provide a better start for the new family. When the birthing woman and her child, and not a machine or a chart, or a schedule or an agenda, are the center of our attention, then no matter what the outcome, the new mother will feel better about her experience and will be better able to care for her child. When we simplify our approach to birth, we will see that birth is simple.

War on Women

My heart is with the women of Goma.

Rebel soldiers captured the town of Goma yesterday morning, while the UN and the world stood and watched.The country's army can do little against the rebels, and the UN soldiers do not have a mandate to strike against them, so they are now in control of the airport and much of the town, according to news from the area. They are moving towards Bukavu today.

Why do we care?

Here are some statistics from the website of the Panzi Hospital, which opened in 1999 in Bukavu, 100 km south of Goma. Dr Denis Mukwege founded the hospital, as a response to a growing number of sexual violence victims in the area. He is still the medical director, and the hospital specializes in gynecological surgery for fistula and for vaginal reconstruction following violent rape. They also provide treatment and support for women suffering the effects of these attacks.

• It is estimated that there are over 200,000 surviving rape victims living in the Democratic Republic of the Congo today.
• From 2006 to 2007, an estimated 1,100 women were raped EVERY DAY.
• Today, it is estimated that 36 women and children are raped daily.

On October 25, 2012, four gunmen attacked Mukwege's home, killing his guard. They fired bullets at Mukwege as well, who avoided them by dropping to the floor.^[2] After the assassination attempt, Mukwege fled to Brussels and the Panzi unit reported that [his] absence has had an “overwhelming effect” on daily operations at the unit.^[3]

Four women are raped every five minutes in the Democratic Republic of Congo, according to a study done in May 2011 by three researchers, including SUNY’s Tia Palermo. “These nationwide estimates of the incidence of rape are 26 times higher than the 15,000 conflict-related cases confirmed by the United Nations for the DRC in 2010,” says Palermo. The level of sexualized violence has received an intense amount of international focus, which has revealed the varied kinds of horrors soldiers have perpetrated against women, even while the country maintains the highest number of U.N. peacekeeping forces in the world. (see here)

As the fighting escalates, families are fleeing from Goma, but they have nowhere to run. There are five DP camps in the surrounding areas and these are full. Families are being separated. Pregnant women are still giving birth, and if a woman survives a gang rape there is a good chance she will have conceived and will give birth. Where are these women to birth and who will attend them?

Montreal Birth Companions doulas have accompanied women from Congo and other countries who have suffered rape and violence at the hands of "freedom fighters" who use rape and sexual coercion as part of their arsenal. These women are strong, and we are honored to accompany them as they give birth. But these are the lucky ones, who have made it to a more peaceful home. Thousands, if not millions, if not billions (One Billion Rising) of women are being raped, beaten and murdered, even as I sit in my comfortable warm living room and write these words.

Please help in any way that you can. Spread the word about this conflict. Donate money to charities that are working on the ground to assist women and children:

Pennies for Panzi is a campaign that is raising money to create a daycare where children of rape survivors can be cared for while their mothers are healing.

Heal Africa provides assistance for women and children in Congo.

Medica Mondiale "supports traumatized women and girls in war and crisis zones."

Safe World for Women is a UK based charity.

This winter season, have a party, do some dancing, and ask your guests to donate money to a worthy cause. If you are a medical professional, consider going to a war-torn country to donate your skills. If you own a company, perhaps you can make a larger donation or donate materials.


Remember how lucky you are.

Bad Science, Bad Medicine, Bad Luck

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?

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.