Trickle Down?

Let's face it ... good stuff doesn't trickle down. You have to work really hard to get the good things in life to the people who deserve them: shelter, medical care, food, clean clothes, and all of those things that many of us take for granted.

In the last ten days, I have had over ten requests from women who desperately need maternity care. I can only provide them with free doula care, from the volunteers who donate their time to Montreal Birth Companions. Some of these volunteers are students, some are experienced doulas.  But doulas don't provide medical care, and most of these women have not had prenatal care, so they are at risk for worse outcomes than the generally healthy population of our fair city.

I was called at 2:30 in the morning last week by a doula, frantic with worry. She had been called by one of our clients who was bleeding heavily. I told the doula to call 911 immediately. She did so and mother and baby survived.

Several times over the past week I have been juggling available doulas to accompany one of the MBC mothers who was laboring and needed companionship. Doulas are people too, some are on vacation, some are pregnant, most have other jobs.

I assisted at a birth where the midwives were unable to provide the mother with effective care postpartum. I was at another birth with a baby who became ill after birth. I got another call from a doula whose client was bleeding after giving birth, and the midwives had not made it to the house on time.

I have had several requests over the past few weeks from mothers who cannot find a midwife, who don't want to birth in the hospital, who are looking for an unregistered midwife. Unregistered, underground, or illegal midwives work without any medical backup and if they need to transfer their clients to the hospital, have no standing with the medical staff and are treated either as doulas or as "friends". Unregistered midwives often make calls that are not as effective as they could be - they work on a basis of mutual respect which sometimes can mean taking risks that may be dangerous and unprofessional.

I am seeing the writing on the wall, and it is telling me that we are not taking care of our mothers and babies. I can't always be there to answer the phone when a mother is in need, or a doula, (and rightly so) cannot provide medical care when there is no doctor.

Something must be done! Se non ora, quando?

Building a Space

Over ten years ago I was in our old living room at our table, with a couple of good friends. Sharon and Sarah have moved on to better things (the music scene and soap making), but back then we were excited about the idea we shared. We had a map of Montreal spread out on the table, and Sharon had some funny stickers. We were putting the stickers around on the map, picking out places where we thought our idea would ROCK.

What was our idea? A place where we could meet with the women we serve, and a place where we could meet amongst ourselves. A place where we could gather. A place where we could have our classes and events. A home away from home.

I started looking that year, and found a tiny bookshop that was closing down (so sad! that's another story) but the rent was too much for a struggling charity/doula group. Sharon moved away, and Sarah started a different business.

I continued creating an organization that could effectively provide doula care for hundreds of families over the years, with no private or public funding, that relies on the goodness and dedication of its volunteers. With insight and determination, I persisted in spite of many setbacks. I created a doula school where many of the volunteers learn the basis of doula care, and others move on to deeper knowledge, or take workshops with visiting teachers. With the income I made from the school and from my private birth attendant activities, I felt justified putting increased hours into the volunteer program. Justified in terms of my economic responsibilities at home: I do not come from an independently wealthy household where charity can be a useful hobby.

I have been dreaming of a space for several years now. This year, everything is coming together. One of my five sons is a chef. We are opening a cafe that will serve quality vegetarian/vegan food and excellent coffees and teas.

But how does this tie in with my original dream? The foundation can be described with one word: self-sufficiency. I want to create a space where everyone can come and feel comfortable, where people can eat and drink together, and speak different languages, and learn about different things. But spaces aren't free, and grants were not forthcoming. So we took out a personal loan, found a place with cheap rent, rolled up our sleeves and got to work. We renovated, painted, and hauled. We bought second hand equipment. My chef learned how to do electricals.

We all pitched in and built, sanded, stained and varnished the counters and tables. A friend sewed us some curtains. Another friend designed us a logo. We scrimped and saved and worked hard and .... we are almost there, opening soon, a home for whomever wants to visit.

Caffe della Pace means the Peace Cafe in English. Come and visit next time you are in the neighbourhood!

Witches

Hard on the heels of news of a very disturbing trend in Spain came one of the most amazing births I have ever been honored to attend. So, I think two posts will have to be written, and I am working hard on absorbing and learning everything I have been experiencing in the past week.

First, the disturbing news. Many of us in the birth world, especially in Europe, have read about the Spanish association of nurses' official report on doulas. This report apparently took a couple of years to compile. It is an attack on the doula in general, and contains some specific accusations against certain doulas in Spain who may be identifiable (only to themselves and close friends).

The document contains some bizarre accusations: that doulas divide families, that they practice cannibalism, that they condone obstetric violence. Because of the bizarre nature of some of the accusations, several critics have suggested we just ignore it as a childish outburst and get on with promoting natural childbirth, and the doulas and midwives who facilitate it.

I don't agree. I believe this report has all the trappings of a witch hunt: the exaggerations, the caricatures, the false accusations, the violence, and the "scientific" pretensions. These campaigns are usually driven by fear and ignorance but at this point I am not really interested in figuring out why, I just want people to recognize that this is important, and must be publicly spoken out against, as soon as possible.

I know that Spain is a country with a long history of persecution and accusation. The Spanish General Nursing Council should be more sensitive to the precedents set by Spain's leaders throughout history, who have shown little ability to look at the facts and make informed decisions. From the Spanish monarchy in the 15th century, who have the dubious reputation of persecuting the Muslims in their midst, burning and deporting the Jews in 1492, then sailing off to new climes to kill and destroy ancient civilizations, through to modern times, when the country rose in flames to kill each other, and lived through a brutal dictatorship right up until the nineteen seventies... Spain has not been a peaceful land. 

We believe, as Birth Keepers, that gentle birth is the way forward for peace on earth. I believe that a renewed campaign against gentle birth keepers is a campaign against peace. It's a campaign against those who are trying to change our abusive, violent birth machine into a place where people of all kinds can birth their babies and their futures.

You may say I am sensationalizing. I know that there were Jews in Berlin who were also accused of sensationalizing when they tried to tell their people to leave. You may say I'm drawing the wrong parallels. I know there is a child in a Spanish orphanage right now whose mother had a home birth with an independent midwife. 

Just last year, an Italian midwife was docked six months of work for teaching a doula training class: 

The accusation against her is that of having violated the Professional Code of Conduct of Midwives by her participation as instructor during instruction courses for birth support personnel known as doulas (defined on that occasion as “persons capable of damaging the health of women and infants”).We would like to take this occasion to communicate that the Professional Code of Conduct of Midwives includes the provision that it is within their scope to provide training for support personnel (art 2.4). The sentence, besides being extremely serious in itself and for the midwife concerned, also casts a shadow over the figure of the doula (cited and recognized as a support person for women in the Care in normal Birth, by WHO – ed. 1996; par 2.5 – and cited in the recent Guidelines to caesarean sections by the Italian Ministry of Health, ed. 2012, pg. 80-82), creating a precedent which we would like to bring to the urgent attention of doctors, midwives, doulas and parents. We wish that this case is brought to the attention of all birth personnel in Europe and the rest of the world." private message, May 26, 2014.

The fact that these accusations are surfacing again, in a different country, is very serious. Europe is a volatile place and the witch hunt against doulas and independent midwives could spread. The campaign could move from bizarre 25 page reports to different types of accusations and investigations. I am not saying this to make people afraid; rather, I am suggesting we should not act out of fear and try to hush things up, worrying that we will be spreading the word that doulas are to be avoided. I am suggesting that we take full action, as full as possible, so that this witch hunt doesn't spread any further. 

What to do?

• Read about it: https://wysewomentalk.wordpress.com/2015/02/17/are-spanish-doulas-really-the-walking-dead/
• Sign the petition: Withdraw the doulas report

• Make a circle: Doulas and Birth Keepers of all kinds need to pull together and stop squabbling. In each country, we need to see a strong organization that represents ALL doulas, no matter where they trained or how they are certified (for example, see Association Québécoise des Accompagnantes à la Naissance).

• Attend births! Educate birthing mothers! Educate the public! Provide doula support to families during the childbearing year! Flood the social media with images and stories of gentle birth!

In the spirit of real birth, gentle Birth Keepers, and moving forward to a peaceful world, let's reach out to each other and be the change we all need.

Losing Your Self

Back in the fall, I went to a birth. It was the first birth I'd been to in a long time. It was wonderful! But it was very different from how I imagined it would be.

I always love the feeling that I am doing exactly what I was meant to do: accompany women during childbirth. The most important lesson about birth is that it is very much like life: you can't really plan for it. Meconium happens. Stuff gets broken. People get lost. Suddenly you turn a corner and there is the most beautiful sunset you've ever seen.

Here is a picture of an obstetrician waiting for an unsuspecting pregnant woman. She is being pulled along to the birthing room by her husband...dropping her slipper like Cinderella...he is rushing to punch the clock ... I'm late! I'm late!

The doctor holds a limp pair of forceps in his hand. He is going to get this baby out, for once and for all!!!

Of course, birth doesn't usually happen according to our plans, or according to anyone's schedule or hourly rate. Babies come when they want, or when they need to leave their mother's womb, or when the womb needs to expel them. Who knows. But they don't generally show up when we plan for them to.

And then when they do, the birth unfolds in a different way from what people had been expecting or planning. Which is why I still don't believe that birth plans are useful. Not because birth shouldn't be thought about and considered deeply, that choices shouldn't be made about where you want to give birth and with which people around you. But because the unfolding of your birth experience, of any birth experience, is unpredictable and can't - shouldn't - be pinned down. Because if you try to capture it with a plan, you could miss out on something extraordinary that you hadn't thought about, that couldn't be contained by your plan.

So, what does that mean for us attendants? How do we plan our days and our lives? 

Birth attendants are often on call day and night. Doulas may be on call for months at a time, unless they structure their work effectively by creating a doula collective which involves sharing care. But most doula clients want the continuity of care that means that one doula is always available. So there go your plans for family events, sleep, trips....

But in a deeper sense, when you are actually attending a birth, when the labouring woman is there deeply in the process of birth, then what? Are you thinking about what groceries you are going to buy tomorrow? No, you are with the labouring woman. You are providing support for her and her family, her partner, whomever. Even if you are sitting in a comfy chair knitting: your intention, your senses, your compassion, your heart and all of your focus are bound up with the birth process and the safe place you are creating for the newborn family to move through.

And then you lose yourself. You forget about your worries, strengths, failures, envies, moods. Your only task is to serve birth. You are serving the woman as she moves through her experience of birth, as she becomes a mother. And are you the most important person in the room? Is the obstetrician the buck upon which stuff stops? Of course not. The most important people in the birth room are: the mother and the baby. And how they are treated by everyone else is the most important aspect of the whole process. So, the less we all worry about ourselves, and the more we focus, truly focus, upon the family-to-be, the better off everyone will be in the end. Losing yourself is just the beginning!

The Shaming of Mothers

More and more evidence is coming out about the dangers of cesarean section. Every time I scroll through my birthy friends' Facebook posts, I see another mega-study that confirms what we knew all along: c-sections are dangerous. Of course, this surgery can and does save lives. But it cannot be true that over one quarter of our childbearing population can't deliver vaginally. 

I believe that for a well-fed, healthy population such as ours in the industrialized worlds, the necessary c-section rate should hover around 5%. Do the math: this means that at least one in five women are suffering unnecessary surgery. This surgery sets the tone for a woman's mothering - it isn't always a traumatic event, but it definitely is a physical handicap and a hurdle that many mothers would rather not have to face. 

I don't want to write about the reasons for these unnecessary trips to the operating theatre; the reasons are varied and complicated. I DO want to talk about how we are making women feel when we constantly post about the dangers, risks, and unredeemable damage caused by cesarean section.

Giant study links C-sections with chronic disorders 

Let's shout it out and make women feel really bad about how they birthed their babies. Let's make them feel even worse about an unexpected c-section than they already do. While we're at it, let's talk about how to have a VBAC: all you need is perseverance, inner peace, and you have to be in tune with your body. Right?

Women are having c-sections they don't want. Women are going to the hospital, sometimes with a doula and sometimes (usually) not, and they find at a certain point in their labor that they are not performing well enough, and they are scooted down to the OR. Most women do not want surgery. Most women want a vaginal birth. Many women want to have a vaginal birth even after a c-section. Just one VBAC support group on Facebook has 8,796 members. 

I am asking all of you to spread the word to not spread the word about how damaging c-sections are. Women who have had an unwanted cesarean birth KNOW that they are damaging. Let's try a little tenderness and spread the word instead about loving the mother, home birth, undisturbed birth, midwifery care, all the good things....

Law Abiding Midwives

We humans have a tradition of honoring the midwife, one way or another, or at least we have ways to remember her and tell our children about her. Whether she is La Befana, who comes on the night of January 5th to deliver gifts to Italian children, or a kindly grandma, we remember her and she is always at the back of our consciousness, for better or for worse.

In the Jewish tradition, we tell the story of the two midwives Shifra and Puah, who worked illegally to continue to assist women giving birth, during the time of the oppression of the Jewish people in Egypt. They refused to obey the Pharoah's command, which was to kill the boy babies. When Pharoah questioned them, they gave him an answer that he couldn't refute, that the women delivered so quickly they couldn't catch the boys to kill them.

That sounds like an illegal midwife's story: when she has to transport a client to the hospital, she lies and says she was "just" the doula, and that the baby came so quickly that she didn't know what to do.

Midwives have been feared. We've been targeted, killed, oppressed, abused... we have been painted as the old lady with large warts who rides a broomstick and eats toads. We were burned as heretics and witches during various periods of human history. We've got magic in our hands, that's certain: we know about birth, life and death ... we know how to comfort a woman who seems like she's dying, and we can heal a child with herbs and loving care. 

In one obscure tradition from the Book of Enoch, some angels were looking down and they fell in love with human women. They got together and fell to earth, had sex with the women and exchanged with them the knowledge of fire, herbal healing, and magic. 

And all the others together with them took unto themselves wives, and each chose for himself one, and they began to go in unto them and to defile themselves with them, and they taught them charms and enchantments, and the cutting of roots, and made them acquainted with plants. And they became pregnant, and they bare great giants.

coltsfoot

Midwives have a great tradition of teaching through apprenticeship. We believe that book learning is a wonderful thing, indeed, the knowledge we have instantly at our fingertips is truly marvellous. The scientific method is an absolutely necessary tool that midwives need to know how to use. But there is nothing to compare to the knowledge that an apprentice gains by witnessing her mentor at work. She learns by watching, listening, using all her senses and intuitions to understand and absorb the skill and art of midwifery.


Midwives accompany women on their birth journey, knowing that it is not always orgasmic and fun. We know how to spot a small dark cloud on the horizon, and when to intervene, and when to send a woman to the hospital, if such a thing exists where we are practising. I recently heard a commentary on natural birth: "Fuck! This is horrible!". She birthed about a half hour later. The pain was immense, no drugs were given, she thought she was going to die, and didn't believe us when we told her otherwise. She birthed, and will always remember how strong she was.

Midwifery is now taught in universities in much of the western world. Graduate midwives then are licensed and controlled by state rules and establishment guidelines. These guidelines are not midwifery guidelines, necessarily. Some of them are in place to help midwives save lives, but others are not. Midwives are put in a difficult position of having to make decisions that go against their knowledge, intuition and skills so that they are not penalized or ostracized by their peers.

I have followed a crooked, witchy path to midwifery, that included being taught by many, many wise women and a few wise men.

Here is a Solstice shout out to the original illegal midwives, Shifra and Puah, and to all the women I know who are practising honest midwifery in the here and now.... you know who you are!

Home Birth and Home Death

Babies sometimes just pop earthside but mostly birthing women want to have some company when they are going through this earth-shaking, phenomenally life-changing event.

I was born with a natural talent to accompany women through their birth journeys. I don't even know what I do most of the time but women tell me they feel better when I am present and quietly witnessing their changes. I tell them that everything is fine. I comfort. I nourish. It's just part of me, hey? I am not writing this because I am clapping my own hand.

When a person sees the woman they love looking like she's probably going to die, because her eyes have gone all weird and she's kind of fainting, they feel better when I tell them that this is normal, she is tripping in a special, life-giving way.

And it is truly magical if this event can take place at home. At home, a woman can run through her whole labor process in her own space. She can barf in her own garbage can. She can make love with her partner in her own living room. She can crawl backwards to the fridge to get apple juice.

She can give birth herself, surrounded by people who love her. She can cuddle with her new child in her own room, and she doesn't need a car seat.

I had a friend back in my hippie organic farming days: she had a c-section for her first child because she was breech, so she had her second on her own. She sent her husband and daughter off for a long walk (!), made sure she had enough methergine from the goat's birth kit, and birthed alone. She told me it was frightening. She would have wanted to have a midwife present, and so the third time around, she invited a midwife along for the ride.

Some women freebirth. These are women who birth on their own or with their partner and children. They trust the birth process implicitly and do not believe they need a midwife. Many women who wish to give birth at home do want a midwife, and midwives are generally respectful of the birth process and knowledgeable about serious challenges, even life-threatening ones, that very rarely unfold during birth.

Right now, in Canada, there is an ongoing discussion about end-of-life care. Many people are suggesting that death moves back home. This sounds all warm and fuzzy but let's look at the reality of this phenomenon.

First of all, I wonder why we are not talking more about bringing birth home? Is the dollar playing a part in this discussion? Possibly. It takes a couple of days, max, to have a baby. Midwifery is an economically viable option if you look at the bigger picture of health care in our country. The women giving birth in our country are, in the huge majority of cases, healthy and well-nourished. Group prenatal classes are popular and prenatal visits are easy to schedule.
Even when birthing women give birth in the hospital, where physicians can make their salaries and the women's hospital stay is almost always less than four days, birth costs less than death.

Dying takes a lot longer. Palliative care can be offloaded to families, private nurses, volunteer organizations and the occasional medical professional for the weeks or months before the final days.

Birth at home is a joy, a beginning, it is a moment that is too short to comprehend, passing in the blink of an eye.

Death at home can take weeks, even months. The family can implode, or explode. Money becomes scarce, life can enter a fog. When the final days come, they can be full of body fluids that no one wanted to deal with, disturbing images that no one can forget, emotional moments better left unspoken. I wonder why people think that birth is "too messy", and they romantically envision themselves dying peacefully surrounded by their loved ones? Have we so lost touch with reality that we think that dying in bed is like in a TV show, where the patient just slips away in the arms of her loyal husband? And the nurses stand around the bed with tears in their eyes?

Death can be just as messy as birth, and often is. I have attended many "clean" births, where the baby is born to a minimum of amniotic fluid, blood, poop, and vernix. But some births are bloody. Some births are full of waters. Some are so astoundingly shit-filled you wonder if it was intended divine humor. Some births have a little bit of everything: vomit, stool, meconium, urine, amniotic fluid, blood ...

People I have spoken to who felt that their relative's home death was a good experience were people who could afford to have a private care giver who was discreetly present for the family, or they were well acquainted with the body and its many processes. Others felt that the family was ill-equipped to deal with the physical death of their relative, as they were going through difficult emotional issues, perhaps complicated ones, and the physical realities were hard-hitting.

I thought I was well equipped to accompany my mother through her dying hours. I had nursed my father for the months he was bed-ridden, and I feel confident in my relationship with bodies.

I was wrong. The constant pain was so difficult for me to bear. I was voted as the family member best equipped to administer morphine. I didn't know if it was the right thing to do, even though I did it every two hours for a couple of days. I was the one who changed the pads. So much liquid! Who knew that the body basically dissolves at death. It wasn't urine. It wasn't amniotic fluid. It was vital fluid, leaking and leaking. Every time I changed the pad it was like torture, for me and for her. I was the one who tried everything to counter the pain of oral thrush. Did you know that this is a sign of the end of life? I have assisted many mothers through the intensity of vaginal, breast, and newborn thrush but this was above, beyond and off the charts pain for the woman who gave birth to me. She couldn't eat. She couldn't drink. All she wanted was a big tall glass of water. She was listening to the poetry in her head. She said that there were raucous voices shouting out her poetry. We put on her favourite music. She breathed very loudly. Even now I awake with a start, hearing that noise. Her body was in pain, the morphine didn't quite cut it.

In the end, the last words she said were: "Is it my birthday today?"

It was a good death, as death goes.

But, please, don't sugarcoat dying at home. Don't be led by the nose to doing something alone that should be an event where there are people present who know what is supposed to happen: Yes, this is normal. Yes, take a break for a little while. Yes, let's let her go. No, the morphine isn't killing her.

A sane culture is one where babies are born at home, where midwives are discreetly present for the woman, her newborn, and her family. A sane culture is one where people can die at home, where death midwives are present for the dying, for the living, and for the continuity of the family and the community.