Refugee Babies

You decide to move to Canada, because in your country, you are hearing stories from neighbouring countries about chemical attacks, schools closing, medical care non-existent. Your friend's cousin's aunt married a man from a country where, ten years after she moved there, she is leaving everything and running to live as a refugee in a country she only visited once before, on holiday.

Your sister can legally sponsor you, and you move to Canada. You and your husband can find work legally, and the children can stay with your sister. You live together in a small apartment, smaller than the one at home but... the future looks good

Even the birth control pill doesn't work 100% of the time. The best way to not get pregnant is to not have heterosexual sex. But, you're in love, you're on an adventure...the sperm meets the egg, and you are pregnant.

You know you don't have medical coverage, but you don't care. You're young and healthy.

Then you find a doctor, who tells you that the birth will cost you at least $5000. If you have a cesarian section, or your baby needs care, it could go up to $10,000 or even $15,000.


I know some people think that the lady in question should "go home". But sometimes that just isn't possible. MBC has assisted women who have been living in Montreal as domestics, for years, and when they find themselves pregnant, they find themselves out of work and out of a home, and without medical care. Other women do not qualify as refugees, but they know if they go home they will be killed, or raped, or they will have to work as prostitutes. It's always easy for you to say, if you're a hard-working person with the good luck to be born into a place where hard work pays, and food is on the table, that "these people" need to act differently. But everyone makes love, and babies are conceived all the time. And sometimes a baby is conceived out of love - and when a woman keeps a baby in her body who is the result of violence and violation, doesn't that woman at least deserve our care?

Babies are being born every minute, and I believe we are ALL responsible for them. If we can assist a mother to have a birth experience that is full of love, and she can leave the birthing room knowing that she is capable of providing unconditional love for her baby, and knowing that she will be supported in this task, then we are paving the way for a better world for all of us: our children, and everyone's children.

Montreal Birth Companions doulas accompany women like these to the hospital to labor and give birth. Many of our clients are single, or apart from their families. Some have other children "back at home". Some have love babies, others have babies conceived during violence. Some have medical coverage, many do not.

If you would like more information about our program, please visit Montreal Birth Companions.

A Response to Dr Gawande

Dr. Atul Gawande's article in the New Yorker, "Slow Ideas"  has been spreading like wildfire on Facebook and elsewhere in the birth world.These are important ideas about change in maternity care and care for women and children overall. Everyone likes his ideas about woman-to-woman communicating and grassroots movements and bringing change one woman and baby at a time.

I read the article and I had serious problems with the language, first of all, but also with the overall set of assumptions about how "we" care for women and their unborn or newborn babies.

Here are my thoughts:

Why did Ibu Robin Lim win the CNN Hero of the Year award in 2011?

Ibu Robin has been working for nearly twenty years in Indonesia, offering free maternity care to women who would otherwise be giving birth at home, in unsanitary conditions, and possibly without attendance. She is on excellent terms with the hospitals in her area, and has single-handedly changed the face of childbirth in Indonesia.

While the goals of the Better-Birth Project are laudable, the inconsistencies in Dr. Gawande’s approach to better childbirth practices need to be addressed. First, there are several simple facts that are misrepresented in his article (“Slow Ideas”, July 29, 2013). For example, it is simply not true that “many babies cannot take their first breath without assistance”.  About 10% of newborns need assistance with their first breath, and around 1 to 2 percent need resuscitation ("Most newly born babies are vigorous. Only about 10% require some kind of assistance and only 1% need major resuscitative measures (intubation, chest compressions, and/or medications) to survive". (Textbook of Neonatal Resuscitation, 6^thedition, American Academy of Pediatrics, p. 39).

Secondly, serious obstetric emergencies, such as shoulder dystocia (rare and potentially fatal, and often unpredictable), are lumped together with common phenomena such as a cord around the neck (around 30% of neonates are born through a nuchal cord). This speaks of an approach to childbirth that is steeped in the western belief that childbirth is an emergency that must be prevented.

It is this approach that will not bode well for underdeveloped countries and their attempts to save mothers’ and babies’ lives. Dr. Gawande describes an effective program: women on the ground, moving from village to village, teaching simple practices that will help to save thousands, if not millions, of lives. But why stop there? Perhaps we can reduce the “twenty-nine basic recommended practices” to just ten. Actually, these 29 practices are only part of an initiative sponsored by the World Health Organization, that is studying the efficacy of a checklist in reducing infant/maternal mortality. It is not yet recommended practice, or even yet proven to be effective . "The formal trial began in 2012 to measure the impact of the Checklist on severe maternal and newborn harm ... Data collection is expected to begin in 2013 and will continue for a period of three years. It is estimated that the study will be completed by 2016."

At the end of his article, Dr Gawande suggests that what made a difference, in one particular woman's life (she was a nurse), was that the expert who was making suggestions about how she could change her approach was friendly. "She was nice." A vision of maternity care that works is a vision that certainly reduces maternal/newborn mortality and morbidity. But it must also be a vision that includes respect for women and their babies, their families, and their culture and history.

I believe that Dr. Gawande’s vision must be taken one step further, and that with just a little more courage and the kind of round-the-clock dedication that I have seen at Yayasan Bumi Sehat in Indonesia, we will start to see dramatic changes in maternity care around the world. We have to reduce the fear of childbirth, and the institutionalized fear of "untrained birth attendants". We can, instead, work with what we have - integrate ten or so better practices into the TBAs practice. Create better and more efficient, low-tech tools for TBAs to carry. Integrate the technology we DO have - mobile phones are used extensively all over the African continent, for example, and find creative ways to save lives. Reduce high-tech interventions. They don't work unless the infrastructure can support them.

Turn your held beliefs on their head: It is certainly a triumph of modern medicine that we can be vaccinated against tetanus. I always keep my vaccine up to date: the old lady who lived at our house in Italy years ago died from tetanus after being pricked by a rose! It is a horrible way to die, and once a wound has become infected, it is incurable.
Newborn tetanus kills babies, every day, in many countries in the world. The tetanus bacteria enters through the umbilical cord, either from unsterile equipment or unhygienic after care.

What if we didn't cut the cord? No wound! No tetanus!!!

Let's work together to find answers to this daily tragedy: mothers and babies deserve better.

Level One Doula Class Fall 2013

Doula classes are starting again in September. This program has been a great success! The doulas that completed Level One in May, 2013 have had a very busy summer attending births as volunteers with Montreal Birth Companions (always working with a partner, as a shadow and then as a co-doula).

Level One will start again on September 9, 2013. Registration is moving along, so if you are interested please get in touch with me for a registration form. See below for a description of the course.

Level Two is scheduled to start at the end of November, 2013.

Birth Companions Doula Course

Level One Description

Fall 2013

Introduction

This course is the first of three levels of the Birth Companions doula program. It includes 24 hours of class time.

Classes will be held every Monday evening starting on September 9, 2013, for eight weeks.

When you have completed this level, you will be eligible to accompany clients from the Montreal Birth Companions volunteer doula program, under my mentorship and with a partner doula. During the shadowing process, you will proceed to Level Two, after which you will be able to work as a private practice doula.

The course will integrate theory and practice. Shadowing and mentoring may take place throughout.

The only prerequisite is enthusiasm and availability.

Materials

Bring your own experiences, a notebook, your hands and an open heart. We will utilize The Birth Conspiracy as our main reference. The book will be available on or before the first class.

Requirements

To fulfill requirements for Level One, you need to attend all of the classes, if possible. I may ask you to present or prepare assignments, but these will be done within class time. If you are interested in doing an independent project, please speak to me and I will be available for mentorship.

Cost

We are pricing this course to be accessible for as many women as possible. The cost for Level One is $400.00. I do not turn anyone away so please contact me about a financial plan.

E-book

E-book!!!

We finally jumped into the electronic age and decided to make an e-book of The Birth Conspiracy available....for all you birth keepers out there who want a light, easy-to-carry version, or for those of you who travel... or for any of you who prefer electronic copies...(I like paper books myself...)

Here it is! You can buy it now for $12 Cdn. Just click on the button below and it will take you straight to the Paypal page where you pay, then you will be directed to the download.

Buy Now

Birth Companions

I work with a group of women who dedicate themselves to some of the neediest pregnant and birthing women in our city. Since 2003, a "small group of thoughtful, dedicated citizens" has provided prenatal education and birth companionship to refugees, non-status, immigrant, and other needy women living amongst us on our affluent urban island.

Last weekend, two women gave birth, accompanied by MBC doulas. One lady was having her second child. She was isolated in many ways: linguistically, financially, and she was suffering an abusive marriage.
The second lady was having her first baby, and she was new to Canada and appreciated the companionship of the two women who stayed with her through the night.

The Montreal Birth Companions spend hours of their time with women in need. They never complain that they are underpaid; they never say how tired they are; they volunteer tirelessly not only attending births but also helping out with the administrative side of the organization.

I would like to share some photos of the doulas, the babies, and the women we serve.

Hands

One of our mothers with her beautiful son

Add caption

New Office - sorting donations

Baby Cutting

"It's just a little cut. Baby won't feel it." Does that sounds familiar? 

I sit in friendly silence so many times when midwives from various cultural places and bases are discussing male circumcision. I've learned over the years that when religion and emotions meet, its better to keep silent. 

But I am surprised and - yes - shocked to see the epidemic of frenotomies and the over-diagnosing of ankylglossia - commonly known as "tongue-tie".

In researching this subject, I found some sites and articles that suggested that the incidence of ankylglossia was about 10%. The suggestion is made that if this condition is not cured when the infant is very young, it could lead to speech and digestive problems when the child is older. But that can't mean that 10% of the population needed to be cut! We do have a pretty sophisticated system of communication, called language, that most of us can manage with quite effectively.

I found a critical summary of research done up to 2004 in a nice online journal that focuses on evidence-based medecine. The studies they looked at came up with an incidence of 1-4%, which is still hefty, but not unreasonable. It is suggested that frenotomy definitely helps reduce maternal pain during breastfeeding. The conclusion that is drawn, however, is that "...in the main this appears to be one of those areas where there is much opinion but little evidence. A much more thorough review [7] concludes that controversy is fuelled by lack of good information about intervention. It is surprising that there is not more good information. Ankyloglossia is not rare, affecting one to four babies in every 100. There is a congenital component, but we know little about other possible associations, except possibly with cocaine use in pregnancy. Clearly there is a need for more research, which need be neither expensive nor complicated. Less opinion, please, and more evidence. A great topic for postgraduate qualifications and the tongue-tied." (http://www.medicine.ox.ac.uk/bandolier/band124/b124-2.html)

A more recent study shows that indeed, nipple pain is significantly reduced and breastfeeding satisfaction is higher when frenotomy is performed on "...infants with signficant ankyloglossia". (http://jgh.ca/uploads/breastfeeding/aaptonguetie2004.pdf

On the other hand, " ...ankyloglossia is relatively uncommon in the newborn population, but inspection of the tongue and its function should be part of the routine neonatal examination. Most of the time, ankyloglossia is an anatomical finding without significant consequences for the newborn or infant affected by this condition. Current evidence seems to demonstrate that despite ankyloglossia, most newborns are able to breastfeed successfully". (http://www.cps.ca/en/documents/position/ankyloglossia-breastfeeding).

No one is arguing that severe ankylglossia will not lead to breastfeeding problems including nipple damage and pain; reduced intake, and a possible consequent failure to thrive. 

However, I am seeing the current approach as akin to the movement towards "routine" circumcision in the U.S. in the post-war years. I assume that the rationalization was based on an understanding of cleanliness and hygiene, and possibly to limit the spread of STDs (with the men just back from a series of battlefields, could that have been a concern?). 

Routine circumcision peaked in the U.S. during the sixties, when up to 90% of boys were circumcised, from around 30% in the thirties. (http://www.circs.org/index.php/Reviews/Rates/USA) 

In the U.K., the rate of circumcision due to diagnosed phimosis was under 5% in the 80's, and even this low rate has been criticized. It has since dropped appreciably, because of a better understanding of true phimosis and an improved diagnostic approach: "...The decline is attributed to the increased use of evidence-based medicine". (http://www.cirp.org/library/treatment/phimosis/rickwood2/ ) It has been dropping consistently in Canada, with most provincial health care plans delisting it. The average rate in Canada in 2006/7 was just over 30%. (http://en.wikipedia.org/wiki/Prevalence_of_circumcision#Canada)

Are we going to have another pendulum swing in thirty years, when we realize that we have been unnecessarily cutting the second most sensitive part of our babies' bodies for absolutely no reason?

When I was interning in Bali last year, at the Yayasan Bumi Sehat, I had an experience that taught me an important lesson about breastfeeding. I came in for my shift at 6am and the intern who was leaving let me know that there was a postpartum woman in one of the beds who was having serious difficulties breastfeeding. The intern was frustrated and worried, and asked me if I could find a way to let the mother know that she needed to be proactive about feeding her baby. 

The woman was twelve hours postpartum, and she was lying on her side on a low bed in the postpartum room. She was wrapped in a sarong but her breasts were bare, and the baby just had a cloth diaper covering his bum. Her breasts were not the best. They were large, with little tone, and her nipples were deeply inverted. I greeted her and asked how she was doing, she was doing well, she had eaten, everything was fine. I asked if I could sit with her. I sat next to the bed and kept my hands to myself. I wanted to get the baby's head, and stimulate her nipple, and put two and two together. But I didn't.

In Bali, you see a lot of people sitting around. People aren't frantically doing stuff like we do. They hang around and shoot the breeze.

I got her some water. Then I sat back down. Other people came in and out. I stayed. She put the baby on and took him off for about two hours, until finally he was well latched and sucking vigorously. 

This baby continued to thrive. I continue to sit on my hands and provide support. Certainly, we have mothers and babies who are not well: mothers get sick; babies have anomalies; breasts (very rarely) don't produce milk. 

If it ain't broke, don't fix it. Don't even try.

Birth and Political Theory?

One of my students has generously agreed to let me post her paper on classical feminism, patriarchy and birth. Read on!

Women as well as men have been discussing the various ramifications of patriarchy and sexism for quite awhile now. A lot of thought has gone into strategy on how to best fight it. However, the root cause often goes unquestioned by those discussing the effects. Some prominent thinkers have attempted to discover the root. Simone de Beauvoir, for example, states that the fundamental reason for women's oppression is her enslavement to the reproductive function. I agree. The female identity is formed not only in a reproductive body but in largely unexamined preconceived notions about that body. As Mary O’Brien, a political theorist and midwife, clearly puts it: the unexamined reproductive process  is the sturdiest plank in the platform of male supremacy.

So where did these preconceived notions come from? Both Beauvoir and O’Brien believe that there was a historical moment that catalyzed patriarchy.They explain that in realizing the reality of paternity and the male contribution to the reproductive process, men created systems in which they could control the process of reproduction. In patriarchy, female reproductive processes are defined by men.These processes, including menstruation, gestation and birth,  have been deemed not only scientifically uninteresting, but have also been mystified as the unknown, the strange, and even the grotesque.

This patriarchal view has clearly permeated the female view of her own body’s function. Even Simone de Beauvoir writes that the mother “is the prey of the species, which imposes its mysterious laws upon her, and as a rule this subjection to strange outer forces frightens her, her fright being manifested in morning sickness and nausea” .To Beauvoir, nursing is “the species gnawing at their vitals.”

Beauvoir, despite her great strides for feminism at her time, does not rethink the significance of the motherhood holistically and outside of male formed systems. Therefore, she, like the rest of patriarchal thinkers, denies the possibility of motherhood as a meaningful and authentic factor of a woman’s identity.  Once we acknowledge that commonly held views on motherhood are not universal truths, we can begin to accept the idea that the female reproductive process gives women a unique connection to the body, cyclic nature, and continuity.

The concept of being pregnant, and experiencing the evolution of having another identity within your body can be an enlightening experience, in which the concept of inner and outer, self and other, become blurred and questioned. In gestation and birth, women engage with the mind-body dualism in a way that is uniquely female.

The poet Adrienne Rich asserts that “patriarchal thought has limited female biology to its own narrow specifications.... in order to live a fully human life we require not only control of our bodies; we must touch the unity and resonance of our physicality, our bond with the natural order, the corporeal ground of our intelligence.” The intelligence and transcendence experienced by mothers that Beauvoir calls an illusion, Rich believes to be a consciousness outside of the narrow specifications of patriarchal thought.

Beauvoir along with other intellectual 20th century feminists are quick to acknowledge the disempowering, enslaving, and unpleasant elements of motherhood in contrast to the stereotypically male roles. Motherhood can be boring. It can be tedious and exhausting. Enslavement to any one role without choice or agency should be fought against, but motherhood is not intrinsically this, despite how patriarchal norms have defined it. There is the real possibility for a powerful female identity that has gone overlooked.

 If the process of reproduction from conception to gestation to birth  is understood, women can form for themselves an identity that experiences authentic creation in reproduction. The identity is formed by accepting the lack of control and the inevitability of repetition in life, by connecting to and understanding the body, and by engaging in the complex history of female subjugation by men, rooted in reproduction.

 It is time to open our eyes to the norms we accept in our hospitals regarding birth. We must open our ears to the patriarchal stories we tell each other that put fear and disgust in the birth process. Most importantly, all people, men and women, must open their arms to all the strong women who both struggle within and celebrate the experience of living in a menstruating, ovulating, pregnant, birthing, nursing, or menopausal female body. Whether it be ignored, mystified, worshipped, or objectified, it is woman’s to dwell within and create.

Hannah McCormick