Wednesday, November 18, 2015

I Did Not Fight Cancer

Many people use fighting words when it comes to cancer. “I battled cancer.”  “My mother lost her fight with cancer.”  

For many, The Warrior Path is essential to their journey, and I honour that.  When I had cancer, I felt a strong aversion to using the language of war.  I chose a different path that I felt worked for me, and want to share another possible way of being fierce in the face of illness.

In 2012 a blood test to investigate pains in my lower back and unusual vaginal bleeding determined my kidneys were in distress and I was anemic to a level that required blood transfusion.   

I was hospitalized, and upon further investigation it was determined I had invasive cervical cancer. Flooded with shock, rage, and fear, I was tempted to fight it tooth and nail. But something in me said, "Breathe".

I went through a procedure in which a tube was placed into each kidney for drainage, since my ureters were dangerously narrowed by the cancer which riddled my pelvis.  After my kidneys were drained and stable, the tubes were replaced by stents in my ureters.  Those stents were hell.

I began six weeks of chemo along with daily radiation.  I received three treatments of Brachytherapy, a process involving radiation directly to the tumors.  I didn’t see these fierce medicines as weapons against my cancer, rather I chose to embrace them as friends that would help me reboot my system to be open to healthier patterns.  I blessed them with such gratitude for their availability at this point in time, as well as the magnificent doctors who had the skills to apply them.

Unmanageable pain was the worst part of the experience for me. There was no real life, as I was either out of my head on drugs or frightening my children with the sound of my moaning.

So did I want to fight cancer at times?  You bet I did.  I had moments of rage and panic, which breed the "fight or flight" impetus.  With cancer that advanced I was terrified of dying and leaving my husband and four children.  I believed I would never feel better, that my “good” days were entirely behind me, and that this existence was all that was left.

I was bitter that cancer was in my cervix.  I was a doula, a veritable cervix fairy, and here was mine obliterated by disease.  I would have taken cancer anywhere else in my body far less personally.  But as a wise friend said, "Of COURSE it's in your cervix!  This is how you will make meaning of this journey."

A few months after treatment, which had showed promising results, I was admitted to the hospital again in renal failure, vomiting my face off and feeling like there were bugs crawling all over my skin.  Three doctors stood at my bedside telling me that an MRI showed a mass near my lower spine, and that if this wasn't metastasized cancer, it would be a miracle.  

I checked myself out of the hospital with re-inserted kidney tubes. I schlepped them around attached to some not-so-sexy looking urine collection bags I wore strapped to my legs. As awful as this sounds, I was grateful for the tubes, as life feels much better with functioning kidneys.

The doctors wanted me to stay in the hospital to get an immediate PET scan to determine the extent of the cancer.  I told them I’d get the PET scan in six weeks as an out-patient, as I wanted to take some time to enjoy feeling stable.  Nobody argued, as there were no medical heroics to be had.

Clear headed and with nothing to lose, I wanted to go deeply within and explore how I was going to live my precious available moments.  I wanted to be with the friends who made me laugh.  I wanted to do things I didn't normally do for fear of being judged, like explore more esoteric healing practices.  I wanted to express overflowing love and blessings to all those who sent me thoughts and prayers for healing, and who supported me in doing the things that nourished my wellness.  I needed to come hurtling out my suffocating spiritual closet into a place of freedom for my soul's expression without caring if people didn't understand me.

I wanted to teach another doula training, but this time include the spiritual aspects of the work.  I had always shied away from teaching from that place of spiritual authenticity because I thought people wouldn't want to learn from me, judging me as being earthy/crunchy woo woo, which frankly is not great for a professional doula's reputation.  I scheduled a course and taught it in Toronto the way I wanted, including ceremony and deep soul nourishment for my beloved students. It remains one of the most powerful gatherings I've ever been part of.  

I drank Cosmos with friends and walked around my beloved city, eating whatever I wanted. I enjoyed my family fully. I focused on life, not the lurking mass. I participated in a Sweat Lodge with a spiritual community in New York state without apologizing to the non-crunchy folks in my life, and revelled in the joy of feeling fully myself.  

On that pivotal trip to Sweat Lodge, I learned from a friend about an amazing school in New York City called One Spirit Interfaith Seminary.  Its program focused not upon promoting any religious dogma, but upon serving as a presence of peace and healing in the world on people's own terms.  Despite my diagnosis, I applied to this two year seminary program in order to become an interspiritual minister, trusting the internal “YES” that guided me.  I chose to love life again, no matter what.

I noticed that relinquishing my bitterness about cancer and choosing to live fearlessly made me feel better physically and emotionally.  I did the things that were meaningful to me without caring what people thought. I kissed my fears of living my real dreams goodbye, realizing that the fears I carried were simply the awesome parts of me I had never claimed.

I discovered that a chapter in the story of my cancer was about a part of me that had grown wild.  I had gotten so caught up in being the mother/wife/doula I thought I SHOULD be, I denied the woman I truly was, and she was demanding to be witnessed in all her passion and ferocity.  Fighting cancer meant fighting myself, and that just didn’t make sense in my narrative.

I have never been religious, but I realized I was still struggling with my concept of "god". Through insights that came from working diligently to heal what I felt was a toxic, disempowering relationship with a disassociated higher power “out there”, I learned to trust what emerged from the higher power within.

I finally went for that PET scan.  When I saw my oncologist a week later he said, “It appears you have no evidence of disease.”  Do I think my approach provided a magical cure?  No.  I think I had a lot of good luck on my side.  But I do believe making peace with cancer left me feeling serene and with the ability to cope with whatever life threw at me.  Had I discovered cancer was still there and advancing, I would not have thought I "lost" any "fight".  I don't see cancer as some foe trying to conquer people. Illness and death are not failures.

Three years later, I remain cancer-free, living a life dedicated to helping people have awesome birth experiences, training doulas to have healthy, thriving practices, and providing spiritual support to folks as a minister.

Many people fight cancer and win.  Fantastic!  That is their story, and I deeply honour it. My intuition spoke to me of working differently with cancer, and learning the lessons it had to teach me.  I like to think it worked for me.  Everyone who sets their foot to the path of healing must decide their own approach, and infuse it with their own belief.

May your motherwit, that innate intuitive knowing, be a strong partner in your healing.  


Friday, November 6, 2015

Trying to Find Your Voice in the NICU: A Mother's Story

I am so honoured to have received this recount of a precious new mother's experience after the premature birth of her son.  I will refer to her as Anne.

Anne's quest for healing after her disempowering experience in the NICU led her to write out her story as an exercise in personal process.  She has generously agreed to allow me to share it.

As a doula, I am rarely allowed in the NICUs in my town. The odd times I am, all I can do is offer support. Parents don't have time to read books I might recommend on evidence based care, and they are not something people generally choose to read in pregnancy, as rarely do people expect, nor should go around fearing the possibility of having a premature or sick baby.  I am not a medical expert.  What I do with every contact I have is say, "You are doing amazingly.  Be strong about saying you'll be holding and breastfeeding your baby as much as possible.  It will be better when you get home."

I can only bolster parents' trust in their own instincts. encourage a lot of question asking in the hopes they will receive correct information, provide information on the benefits of Kangaroo care, and listen heartbroken to the parental feelings of overwhelm and self-doubt.

Parents are so busy in the NICU and catching up on rest, that our communications are usually few and far between, their focus completely taken up by the care of their child and themselves.  As a doula, I make sure my communications are calm and as encouraging as possible.  The best healing I can bring is to love them up when they get home (where I am allowed to be with them as long as they wish, unlike in the NICU), and support them as they begin to reconnect to their fractured motherwit.

Even the fiercest and most knowledgeable of self-advocates may, at the mercy of postpartum hormones, exhaustion, fear for their baby's health, and perhaps even a sense of guilt about not wanting to seem ungrateful for the fact their baby is in loving, capable hands, be at risk for being completely railroaded by the environment.  It hurts when my role becomes more about emotional damage control than being able to do much practical support as I can in a birthing room. When I do have the opportunity to be in the NICU, I am treated as someone taking up too much space, and am often told impatiently that I can't be there much longer.

It is my wish all parents, health care providers, and doulas take away from Anne's and her partner's story the inspiration to  participate in the creation a more nourishing, correct information providing, and parent/baby-as-symbiotic-unit approach to caring for families spending time in the NICU.

Here is her story:

Trying to find your voice as a new parent in the NICU

Advocates for less medicalized births often talk about the dangers of the “cascade of interventions” when laboring in hospitals and they encourage pregnant women to be as informed as possible when deciding what they do or don’t want or need while birthing. I am a researcher by profession, and so when I was preparing to give birth to my first child, who was born this past September, I really heeded this call. I feel empowered when I am informed. My husband and I read books on pregnancy, birth and breastfeeding, among other topics, we hired a doula, we attended birth prep and baby care classes, I scoured literature reviews on baby health and safety issues, and as a result, we both felt relatively informed about the process that was about to unfold in front of us. We knew that there was no such thing as being “ready” to have a baby, but having spent so much time reading and listening and talking gave us a sense of the kinds of possibilities and issues that could arise during this huge life transition, and it felt good to feel like we were not going in blindly and like we had enough knowledge to be able to make decisions that were right for us when the time came.
The unfortunate catch-22 of preparing to have a child is that you will most need to feel educated and informed when things do not go as planned, and yet it is both not realistic and not healthy to prepare yourself for every little thing that can go wrong. Most writing that calls for less medicalization of moms and babies assumes a context in which everything goes relatively normally – it is often reiterated that healthy births are not “medical events”. But how can we maintain our agency and our dignity when they do become medical events? What I want to reflect on here is the difficulty of trying to be informed, advocate for yourself and make healthy choices for your newborn outside that “normal” context. When my water suddenly ruptured just a day shy of 35 weeks pregnant, I was prepared for the very easy and uneventful birth that followed. What I was not prepared for were the 2 weeks we spent in the NICU afterwards, and how we would struggle to make the right choices for our son in such a constrained and often enigmatic place. We had not done our research on caring for a preterm infant – why would you? And while our son received loving and attentive care during those two weeks and is now thriving, we found ourselves stressed out, disempowered and really struggled while he was there. It was an experience that really marked us and shaped our early days as parents, and one that I am struggling to let go of.
We often found ourselves invoking the “cascade of interventions” not when discussing my birth, but while trying to make sense of what was happening to us in the NICU. Our son was born at 35 weeks on the dot, screaming, for which I will always be grateful. A neonatology team was in the room and examined him within minutes of his birth. He was just shy of 5 lbs and they quickly declared him healthy and said they did not think he would need any time in the NICU. I had about four glorious hours of skin to skin with him before that opinion changed because he repeatedly flunked his blood sugar test. We consented to have him taken to the NICU to help sort out his hypoglycemia, and we were told that this was such a minor issue that we were looking at an overnight stay, at most.
I was wheeled into post-partum and a nurse gruffly gave me a breast pump and told me I was going to need to start pumping. Assuming that everything would go normally, I had never even looked at a breast pump before, nor did I know how to use one, much less all those “tricks” I know now to pump more effectively. I got very brief instructions and then warnings about keeping up with it or else I would mess up my milk supply. I visited our son in the NICU as soon as I had settled in, and I was truly moved by the kindness of the nurse who was gentle and reassuring as she completed his intake. But seeing him small, vulnerable, in an incubator and hooked up to monitors was heartbreaking. When the nurse wasn’t looking, I opened the incubator door and put my hand in to hold his little hand and touch his head. I felt like I was cheating. No one had thought to tell my husband or I, that first day, that we were actually allowed to hold our child and do skin to skin with him. It was only while texting about it with Lesley that she mentioned that NICUs always let their parents hold their babies except in the most dire circumstances, and so I worked up the nerve to ask. Those first hours I just stared at him in there and tried not to cry.
This was a running theme of our NICU experience – the strange feeling of needing to ask permission to care for your own child. It was two days before we would even change one of his diapers. Our son’s hypoglycemia cleared up within 24 hours and so we were excited to go home. However, the IV he had in got messed up and needed to be removed, so a nurse suggested putting in a gavage (feeding tube that goes through the nose) instead, as it would be less invasive and less prone to infection. We consented. They had made it seem like no big deal. What we did not know at the time was that NICU protocol almost everywhere is that once a baby has a gavage, they will not be released until they eat without it for 24 hours. And so while the issue that brought us to the NICU had disappeared, the gavage kept us there for two weeks. We were now there for feeding issues. No one thought to mention this change in medical concern. It would be days before we really understood why we were there.
This was another running theme of our time in the NICU; the lack of true informed consent. No one explained to us what it meant to put that tube in, and then we felt blindsided when we got stuck there like we did. Gavaging preemies is a really standard, common practice in NICUs; there was no reason not to explain to us the implications of going down that path. The absence of clear information was not for lack of trying on my part. For example, our son had a moderate/borderline severe case of jaundice, and I asked our attending resident some questions about how they were making the call whether or not to treat it for three days in a row before I finally got a reply that explained their decision and the risks and benefits that informed it, rather than just reiterating it. (If I remember correctly, that eventual reply actually came from the attending pediatrician.)
Our son’s new diagnosis was “prematurity”. There was nothing wrong with him; he was just young and struggled to stay awake long enough to eat. NICUs have very particular ways of measuring what that means. They do 8 feedings a day, every three hours, and they use the baby’s weight to determine a set amount of milk or formula the baby needs to be able to ingest at each meal. “Feeding on demand” was out the window. I had very little colostrum, which I now understand to be normal, so he was immediately started on formula to meet the quantity they had determined he needed. If we put him to the breast, which many nurses encouraged, whatever he got at it did not “count” as it could not be measured. Breastfeeding was therefore mostly for “practice” and to help with my supply, but he still needed to get a set quantity either by bottle or by gavage. If he fell asleep finishing a bottle, the rest would be gavaged. The NICU was very encouraging of breastfeeding, and yet the fact that you cannot quantify it the way you can a bottle meant that for all the breastfeeding tips I received, bottle-feeding had to be our focus. By the end of our stay I would feel guilty if I put him to the breast for a feed because I worried (incorrectly, it turns out, but this is what I was told) that it would wear him out for his subsequent bottle and we would get stuck there longer because of my stubborn insistence on breastfeeding.
I would pump at least every three hours in order to try and give him as much colostrum and then milk as possible. Those first few days, nurses kept asking me if my milk had come in yet – at one point a hospital lactation consultant told me that because it was day three after a vaginal birth, I should expect to be engorged within the next twelve hours. I watched the clock. It didn’t happen. I thought something was wrong with me. The doctor would do his rounds every morning, conferring with nurses and residents within earshot of me and my son in the incubator, talking about us in the third person. “How’s mother’s milk?” he would ask, and they would always answer that I had a weak supply. The first few days, my son actually hated the formula and refused to drink from it (we had much more success getting him to drink pumped milk from a bottle); with my supposed weak supply, I felt like I was failing him and keeping us in there. What no one told me, until a kind doctor on one of our very last days there, was that my supply was weak because we were there, and that most women experience supply issues when they are in the NICU, because they are stressed, and are only allowed to put their babies to the breast a few times a day, and because the pump is not as effective as a baby at dictating how much milk to produce.
I heard a million comments over those two weeks, which were innocuous in their intentions, along the lines of, “wow, you don’t have a lot of milk, do you?” Never say something like that to a post-partum mom. I held back tears every time. Those comments crushed me. I wish I had known that it was just because I was there. I saw so many mothers who, by the end of their stay in the NICU, had given up on breastfeeding, quite understandably; pumping 8-10 times a day only to produce inadequate milk is brutal. It felt like the hardest thing I had ever done. I would set my alarm at night to pump and every time I woke up I would feel disoriented, wondering where my baby was, and sadly trudging to the pump instead. I had constant nightmares. It felt profoundly wrong, in this really primal way, to sleep and wake at night without my son there. When we came home it was such a pleasure to wake to a crying baby instead of the breast pump.
I do not debate that our son probably needed to be in the NICU. It would have been incredibly stressful trying to feed this small and sleepy baby all by ourselves at home. There is a decent chance we would have ended up there anyway. NICUs are amazing places that work very hard to care for often very vulnerable babies, and the nurses we encountered there, with literally only two exceptions over a two week span, were among the kindest, most caring people I have ever met. I cried while saying goodbye to them. They taught us how to care for our son; how to swaddle him, bathe him, burp him, and they were always encouraging and gentle with us. They are the most talented nurses I have ever encountered and they worked their asses off as NICUs in Montreal are painfully understaffed, often pulling doubles or giving up days off, coming back early from sick leave or taking on more babies at a time than they were supposed to. My son was in very good and loving hands and I think about them with enormous gratitude every day.
What made our time in the NICU so difficult was mostly not the individual caregivers (although I will mention a couple of exceptions below), but the larger structure of this place and how it worked. The nurses were kind, but the system itself was incredibly unkind. We ended up in two different NICUs; first, a huge high-level NICU for 5 days, which then (mercifully) transferred us to a lower-level one closer to home for the next ten days. The higher level one had 75 beds for babies, and only three courtesy rooms for the parents to sleep in, which we therefore had to fight for every day. Doctors talked about us in the third person, but spent little time talking to us. Our son was on such a strict schedule that we generally had to ask for permission to do things like take him out of his incubator. He was hooked up to heart and respiration monitors despite there being no concerns about his heart or lungs; it was just standard protocol to monitor him. This might seem like a little thing, but he was talented at ripping the monitors off (our little rebel!) and so they would constantly malfunction and the beeping frayed our already damaged nerves. And on a less avoidable note, it was brutal experiencing that post-partum hormone crash in a place as frenzied as a high-level NICU. There were sick babies, harried parents and alarms going off everywhere, and we all felt very keenly how fragile all these little lives were. It is just a really hard place to be. Between sick babies and crazy hormones, I realize now that I was probably the most emotionally vulnerable I have ever been in my life during those two weeks, and I therefore had to navigate all of the issues I am describing here feeling like a walking open wound.
Experiencing all of this is especially brutal when it feels like a machine that is much bigger than you, where there is more action than information. Like the example of when they put in my son’s gavage or monitored my son’s jaundice, informed consent was hard to come by. Despite this standard 24-hour feeding rule, every day in our first NICU they made it seem like we might be going home imminently. They told us they did not want to make any “predictions” that would give us false hope, and so all we ever heard was “at least until tomorrow.” We ran ourselves ragged and therefore didn’t really sleep for 5 days thinking that this was a very short-term stay. When we arrived in the second, lower-level NICU, a kind pediatrician, in his initial assessment, told us, “you will be here for a maximum of ten more days.” I just about burst into tears, as that was so much longer than we had expected, but we were so, so grateful to have someone give us an idea of what was to come, rather than being evasive. His assessment was prophetic as it was exactly ten days later that we went home.
While most nurses were truly gifted caregivers doing their best in impossible circumstances, we nevertheless felt very vulnerable when it came to the couple we encountered who were not. One nurse that we had over two nights described herself as “old school” and told us she did not believe in skin to skin or bonding, nor did she know anything (nor really care) about breastfeeding. Our baby was a medical problem to solve, not to snuggle. She made my husband feel particularly unwelcome visiting our son at night, and so we eventually stayed away as much as possible while she was around in order to avoid conflict. We realized that there were two approaches to caring for babies in the NICU; one that saw only the babies as the patients, and another that saw the whole family as part of the caring process. I know now that all medical evidence about newborns shows that they and their parents are basically one entity in the early months, and that their health is inseparable. Nurses like this one, who believed that their only responsibility was to the baby, were going against pretty much all current research.
It was during his first night with this nurse that my son began to have bradycardias, which is a brief deceleration of the heart caused by his still-developing nervous system. We were repeatedly assured by all medical staff that these were harmless unless they started occurring extremely frequently, yet they somehow made a big deal of them every time one happened anyway, such that they felt terrifying. It becomes hard to assert yourself when you are terrified. What I did not know until I did some reading once we got home was that the best cure for bradycardias is “kangaroo care”, i.e. extended skin to skin contact between mother and baby. After our terrible first night with this nurse, which left me sobbing on the phone with my mother, I kept saying that it could not be a coincidence that this problem had cropped up with such an unkind caregiver. I now know just how right I was. Her “old school” approach actively impeded his development. And yet when the doctors did their rounds, all they noted was the bradycardias, without reflecting on where they came from or the context in which they occurred.
While that was the most extreme example, we still found ourselves at the mercy of nurses’ and doctors’ often subjective opinions. In our second NICU, there were signs at every incubator encouraging skin-to-skin contact. My husband and I would spend about 16 hours a day there, holding our son as much as we could, trying to make a place as weird as the NICU as normal as possible during those formative first days of his life. During one exhausted night towards the end of our stay, a nurse got fed up with how much we held him, and told us our son would rest better in the incubator. Sheepish, we put him back in the incubator and prepared to leave for the night, but I wanted him to fall asleep first. He lay there, eyes open, hiccupping, unable to fall asleep as well as he did in our arms, for about an hour, while I held back tear. I put my hand into the incubator and lay it on his head, afraid to touch him more because we had just been chastised. He looked tiny and alone and I cried the whole way home.
The next day we asked the attending pediatrician about this, who of course confirmed that the nurse was wrong, and that in fact babies rest better through skin to skin than through an incubator, which is a machine trying to simulate that environment. She said that as he was a healthy baby who just needed some time to grow, “TLC” was all we could really do for him at this point. This helped us feel more brave about insisting on holding him (and at least this NICU allowed us to hold him without permission, although we still needed their OK to feed him), although certain nurses then viewed us as “difficult”.
Similarly, when it came to feeding, some nurses would come over beforehand and discuss with us our options for the next feeding – should we try breast, bottle, gavage, or what kind of combination of these methods? They trusted that even though they were the medical professionals, we also knew our baby as we spent all day with him, and could read his cues regarding how awake and hungry he was at any given feeding. Others would come over and tell us, without asking our input, that X method was best for the next feeding, in particular treating me as difficult if I insisted on trying even five minutes at the breast beforehand. I was once chastised for taking my baby out of his incubator when he woke up hungry a bit ahead of schedule and putting him to the breast, figuring that it couldn’t hurt to do so while we waited for the nurse to prepare his bottle anyway. Watching my baby root around because he woke up 15 minutes ahead of schedule and not being allowed to feed him seemed counter to any common sense about how to help a baby whose principal health concern was his ability to eat.
The very same doctor mentioned above eventually let us in on the secret of the NICU, at least when it comes to things like helping preemies develop and learn to eat independently, rather than treating specific illnesses that one sees in more serious cases; as she put it, “it is not an exact science”. Frustrated by the gavage, which I worried left my son so full that he did not feel enough hunger to work on his feeding, and by the different approaches of the nurses to feeding him such that our experience seemed to depend so much on the individual opinions of whatever nurse was assigned to us on a given day, she admitted that the process is very much subjective. She also said that the obsession with him ingesting particular quantities was not evidence-based nor actually particularly essential – they could tell if he was eating enough the same way all parents of full-term babies do, through diapers and weight gain – but rather it was a liability issue, i.e. to have numbers on record to prove that the hospital had fed a baby enough in case anything happened. So my stress about not pumping enough, the formula, the dictatorial schedule with bottles all the same amount - that was less about what was necessary and more about making sure we couldn’t sue them were anything to go wrong.
Our son got amazing, attentive care in the NICU. But we were not prepared to navigate its procedures, because who prepares to spend two weeks in the hospital with a premature baby? After we were released, I read up about kangaroo care for premature infants, about best practices suggesting that the parents care for the baby as much as possible, about how to encourage breastfeeding, etc., and I could see all the questions we could have asked and all the places where we were not given the opportunity for informed consent (either in terms of information or in terms of consenting). We got very, very lucky when our son was discharged, because we happened to have a nurse that day who really cared about breastfeeding, and faxed in a referral for us for a breastfeeding clinic as well as asking the doctor to give me a prescription for domperidone to help get my supply up. I am not sure I would still be breastfeeding were it not for her encouragement and those resources she pointed me to. People like her helped us survive.
Nevertheless, adjusting to home life after such a quantified experience of infant care was rough. We were so happy to be home, away from the sound of beeping monitors and able to feed and snuggle our baby whenever we wanted. But as I texted to Lesley in the immediate days afterwards, I felt like my “mother’s intuition” was broken. We were used to looking at a monitor to make sure our son was breathing, rather than looking at him (and trusting that he was probably breathing). We had no idea how to wean him off the bottle to encourage him to take the breast. It took me a couple of weeks to believe that he was getting any milk at the breast at all. He did not know how to feed on demand. All is well now, but it took a full five weeks to get back fully breastfeeding, and to emerge from the path that the NICU had started us on.
Advocates for less medicalized birthing and more natural parenting spend a lot of time talking about “evidence-based” practices and the tendency of large institutions to move slowly when adapting to research and to be very conservative for reasons often more related to liability and convenience rather than actual need. The NICU is, of course, a very “medicalized” space by necessity, as it should be when it comes to healing sick babies. But I should point out that parents of sicker babies than ours probably need the transparency and compassion we ached for even more than we did. Having had the experience of trying to care for a healthy, just undercooked, baby in the NICU, it is so hard to find the balance between the medical and the, well, normal. It is clear he needed help learning how to eat, for example. But the way in which he was given a gavage was confounding; not only was there no informed consent, as I explained above, but it also felt like they had created the problem (baby is being fed by tube) that we now had to fix, which due to their systems, required a bottle. In short, it felt like they broke him in order to fix him. In reflecting on our experience, I have spent a lot of time thinking about what more humane care for premature babies would look like – it is obvious, for example, that it would involve babies rooming in with parents and more real breastfeeding support (rather than mere encouragement that it is a good idea) and less obsession with the quantitative. It would allow for feeding on demand and parents doing most of the care of their babies themselves. All of these things, however, could not work in hospitals concerned with liability issues and would require infinitely more resources; how could feeding on demand work with busy nurses’ schedules? And how could there possibly be enough rooms to allow parents to room in with babies? And so for all my hard feelings about my experience, I get why NICUs are the way they are; we are kind of stuck in the system that we have.
And so I am left with this question of how parents can apply the ethos of gentle, informed and respectful birthing practices to medicalized environments like the NICU. We were so ready for birth and yet so blindsided by what came after. How can you maintain your agency as a parent and your right to care for your child when you find yourselves unexpectedly hospitalized? And why is this experience staying with me like it is? Life is great now; our son is healthy and, if you ask me, perfect. And yet I still find myself thinking back to those early nights, full of hormones, waiting to be given permission to hold my son, trying to remind myself to look at him to see how he was doing rather than at the monitor. Why was this experience so destabilizing?

I am simultaneously so grateful to the NICU for caring for him and getting us through his prematurity and yet angry that we were often left out of the decisions made about his care, and allowed so little room to maneuver within that larger system. It is hard to balance that gratefulness and that anger. I might feel differently had he been truly ill, but we were in the strange position of having a totally healthy child and yet having his care really quantified and medicalized nonetheless. This was hard to negotiate and impossible to prepare for. What I am left with is the same wish that many birthing advocates have for laboring mothers; more transparency, more information, more concern with giving parents agency and helping them make empowered decisions about their babies. Even when things do not go as planned and we find ourselves requiring medical intervention, it does not mean the process needs to be so unkind and opaque. I wish I knew then what I know now about caring for premature infants, but surely I shouldn’t have needed to have prepared myself with mountains of research to have had a more humane experience. Humanity in such stressful situations should be the norm.

Monday, November 2, 2015

5 Ways to Prevent Disappointment in the Delivery Room

According to studies cited by PATTCh, an organization dedicated to the Prevention and Treatment of Traumatic Childbirth (, 25 to 34 per cent of women report that their births were traumatic.

Everyone comes to the path of childbirth with different values, needs, and desires.  There are no two pregnant women alike.  As radically different as "ideal" birth dreams are from woman to woman, most agree that the experience of birth matters to them.

But what if birth goes differently from what you had hoped? 

As a doula and childbirth educator for over 22 years, I have seen some of the hopes and dreams women nurture during pregnancy dashed violently against the rocks of surprise.

Here are five ways to approach your birth day that will decrease the possibility of not only disappointment, but of avoidable trauma.  They will also potentially increase your chances of feeling like a rock star about your birth.

1) Have Realistic Expectations

Upon hearing women recount their birth stories, it is apparent that many believe a labour that lasted 18 to 24 hours was long.  In fact, 24 hours is normal for a first birth experience.

 It will serve you better to expect your labour to be on the longer and harder side.  This will inspire you to mobilize some techniques to help you pace yourself.  Patience is a key element in coping with labour. 

When your expectations meet the reality of a normal labour, you will not react with fear or concern.  You will be more prone to remain relaxed, which actually helps you to labour more efficiently.  It tends to be psychologically easier on women to discover they are more advanced in their labour than they thought (providing they are in an environment that feels safe to them). 

If you expect your body will open according to a formula that can be dictated by an app, believing that times of contractions go according to a dependable curve and can predict how close to full dilation and delivery you are, you could potentially a) think you are WAY farther along than you actually are, which is mojo crushing news to hear when labour is intense, or b) birth in the car.

A clock or an app can never tell you when your baby will arrive. You will very likely know when it is time to take labour seriously because your body will tell you.

2) Prepare for the Unexpected

It is a good idea to have some solid coping skills under your belt in order to meet whatever labour throws at you with confidence.

You may not end up with the natural birth you'd hoped for. You could give birth too quickly to get that epidural you wanted.  Or, you unfortunately find your epidural doesn't work quite the way you thought it would. You may not have read the chapter in your birth books on Cesarean, end up needing one, and experience more anxiety than necessary because you didn't have an idea of what to expect.  

Take good, unbiased, evidence-based prenatal classes that respect personal choice and furnish you with simple labour coping techniques.  Know your options at your place of birth (including for your contingency plans), because without clearly understanding what is available to you and what your rights are, your options are limited.

Leaving it all up to chance with an "it will be what it will be, the experts will decide everything" attitude can deny you the opportunity to truly own your experience.  I have found this approach to have a higher likelihood of leading to disappointment and trauma.

Practice your breathing and relaxation, which can be applied to any birth situation, expected or not.  Ensure your birth partner knows some good massage techniques to help with comfort.  Be open to everything and attached to nothing. Stay centred.  

3) Find Your Centre

At the end of the day, no matter how you end up at the big moment of delivery, it is often the baby who decides how they need to come into the world.  

You can indeed influence the quality of your birth experience with good diet, good prenatal care, good prenatal education, and a positive attitude which affirms that the normal birth process generally works magnificently.  But you cannot control the outcome.  It is ultimately a mystery.

What you can do, is practice having some mastery over your responses to what is going on inside you and around you.  You can start now.  When something hurts or gets on your nerves, take a deep breath and repeat to yourself "Nothing can disturb my peace," until you actually feel anchored to the changeless peace that rests beneath every experience.  Think of it like being the whole ocean instead of just the waves.

This way, you learn to discern that whatever is going on in your field of experience is just one small part of any given moment, and it too shall pass.  Being centred helps you to refrain from jumping down the rabbit hole of  fear and tension in response to the challenges labour provides. This will serve you as you work through the sensations of your birth experience, as well as in difficult parenting moments.

Your ability to access this centre is the greatest tool to have when contractions start coming on strong, or waves of anxiety threaten to crash in on the day of your planned C-section. 

Being centred doesn't mean you will behave with Zen like calm.  It just means that while you're coping with labour in whatever way you do (yelling being a perfectly valid way), you feel connected to a source of inner strength and self-trust.

4) Trust Yourself

Having witnessed hundreds of births, I can tell you that in pregnancy, birth, and motherhood, women often develop uncanny intuition when it comes to their bodies and their babies. They may doubt it, as intuition is not something we as a culture have a lot of practice validating within ourselves, but it is there nonetheless. 

As a young pregnant woman, I was amazed at how intuitive I felt about my needs for birth. I am glad I trusted them, as I sense my birth experiences would have turned out differently had I not.

As a mother of four, I rely a lot on my gut when it comes to making parenting decisions, and you will too

As you and your baby are a symbiotic unit, it isn't a stretch of the imagination to realize there is a deep connection between the two of you, and can lend to your having insider information about what is best for your situation.

5) Get Support

Ensure the people you have on your birth team know what you want, what your greatest concerns are, and are prepared to stand by your wishes whenever possible.  They should take time to address your questions and concerns, listen to you, explain your options, and support your choices. 

The Cochrane Review, a well known medical journal states: "Continuous support in labour increased the chance of a spontaneous vaginal birth....and women were more satisfied."  

Support can come in the form of a friend, a family member, or a professional doula who is trained and experienced in providing information, comfort measures, and empathetic guidance to women and their partners throughout labour and delivery.  

Having felt supported, heard, understood, loved, and upheld as active participants in their decision making process wherever possible is what women report helped them feel good about their birth experiences...even if they didn't go as expected.

On the day your little bundle of joy arrives, it is my greatest hope that you feel like a rock matter what!  Because your birth experience truly matters.

Saturday, October 17, 2015

The Heart of Grace: Pregnancy and Infant Loss

October is Pregnancy and Infant Loss Awareness Month.

As a doula with over two decades experience, an inter-spiritual minister, and one who supports the dying, I have held space for the grieving of early and late pregnancy loss.  

There are times my support has been in the moment and in person, emotions ranging from disappointment and sadness to the keening of shock and soul shattering grief as a baby lies still in its mother's arms.  It has at times been over the phone because a doctor referred someone to me for emotional support.  It has been at times listening to a friend, student, or client discuss a recent or long ago loss.  

Each story of pregnancy loss is woven into the intricate patterns of the exquisite fabric of women's reproductive lives, into the stories of Family.  Each is a reminder, some poignant, some resentful, and some unreconciled, of the Mystery of life's unfolding.

It is always humbling to be invited to bear witness to an account of a parent's experience of loss. Loss expresses itself in a myriad of ways.  Sometimes it is quiet and gentle.  Sometimes it is fierce and raw.  I have found it best to be with exactly how it is for that parent, and to simply breathe into the moment, hollowing out my being, so that I may serve as a vessel of compassion and empathy.

When sitting with someone who is losing or who has lost the child they've conceived, there is little to say.  I have given up trying to find the words that will heal.  Because there aren't any.  There are no pretty words to ease a grieving mama's heart.  The space we hold for the unburdening of these maternal feelings is best filled with our listening presence.

"Listening is the oldest and perhaps the most powerful tool of healing.
It is often through the quality of our listening and not the wisdom of our words that we are able to effect the  most profound changes in the people around us.  When we listen, we offer with our attention
an opportunity for wholeness.  Our listening creates sanctuary for the homeless parts within the other person.  That which has been denied,
unloved, devalued by themselves and others.  That which is hidden."

-Rachel Naomi Remen

The loss that occurs in late pregnancy, during birth, or just afterwards is an unspeakably painful thing for the parents, as well as for those who love them.  Even for those who are just acquaintances or have heard of the loss through the grapevine, feelings can be complicated and uncomfortable. Eyes are lowered, we often don't know what to say, and we are generally quite unskilled as a society at communicating with bereaved parents.

I heard it once said that there are terms for people who have lost partners ("widow" and "widower") and for children who have lost their parents ("orphans"), but there isn't one widely known word for a parent who has lost a child...perhaps because it is a grief society can little bear to even think of.  But our not addressing loss keeps us unskilled, to the detriment of the parents.  

A few years ago, a wonderful woman I see regularly for self-care services was pregnant, and we would talk animatedly about birth whenever I went for a visit.  Then one day I learned from one of her co-workers that she had lost that baby very late in her pregnancy.  

I am a doula, for Pete's sake, with experience of loss support, and even I found it hard to go back to her place of work again knowing this elephant would be in the room between us, and would grow more insistent with each passing moment it was left unacknowledged.  But how to acknowledge it?  Leave it on her shoulders?  Bring it up myself?

 I experienced a deeper understanding of how those who are frightened of this kind of encounter could squirm with discomfort at the idea of having to talk to a grieving mother and not know what to say.  I could imagine what might go through their minds if they were in my shoes. "What if I open the floodgates of pain and we all get caught in the deluge of overwhelming emotion?"  "What if she gets mad at me for saying anything?  Or worse, for NOT saying anything, even though it it clear she doesn't have a baby in her belly anymore?"  "What if I say the wrong thing?" "I just can't deal with her, so it's best to ignore her and tell her I've been busy if I run into her." "Maybe I should just change service providers." 

Staying away from the grieving is something some people choose, because they just can't deal with the potential for intense and overwhelming emotions and the fear of messing up.  While I can understand that impetus, knowing it comes from fear and not a lack of caring, it certainly doesn't help to ostracize grieving parents. 

I made an appointment and went to see this woman as usual.  She walked into the room, appearing pale and subdued.  It was clear she was uncomfortable too.  I was a doula she had shared intimate details of her pregnancy with, and she was no longer with child. She knew that her clients had been informed about what had happened, according to her own instructions, but that didn't make encountering people any easier.  I took her wrist, looked her in the eyes, took a deep breath, screwed up my courage to take the risk and said, "I heard you lost your baby.  I don't have words for how sorry I am."  I am sure there are some mothers who would have preferred to not have me bring up the baby and announce the death themselves themselves.  But because the "rule book" is so complicated and conflicting, at some point we have to listen to our hearts for the answer how to approach and take a risk.

 The elephant in the room shrank and shrank as I simply listened to the story that wanted to come out in a presence that was committed to only listening.  There were tears of sorrow from both of us.  She told me her child's name, told me about the birth experience, told me the things people said to her she didn't like ("Your baby is in a better place," "God wanted your baby back as an angel," "You're young and healthy, you can have another baby."), expressed her anger that her place of work was holding a baby shower for a co-worker who was pregnant and that she couldn't take it... and so many other things.

To this day, years later, she tells me little things about her child, about the box she has of keepsakes she hasn't yet opened.  It hurts to talk about that baby.  But for her and for many, it hurts more not to.

One of my favourite books on late pregnancy loss is a memoir called An Exact Replica of a Figment of My Imagination by Elizabeth McCracken.  It was given to me by an amazing client of mine whose first baby was born still, and whom I supported throughout the pregnancy and birth of her beautiful Rainbow Baby.  This woman and this author provided me with such insight into the uniqueness of the experiences infant loss.

Early pregnancy loss is an experience many women go through.  And it saddens me how little honour there is for the time it can take for many to heal from these losses.

For one, many people assume that just because it's an early-ish loss, it's not a big deal compared to a later loss.  That is certainly not the case for a lot of women.  A women discovering she had a blighted ovum can experience tremendous grief, because once the dream of a baby has infused a woman's heart, she has often identified herself as a mother-to-be.  The loss of the dream of a baby can be profoundly heartbreaking.  It is not for anyone else to prescribe how long a grief "should" last with regards to an earlier loss or the loss of what she thought was a conceived life.

Another example of the general lack of honour our culture has for early pregnancy loss, is with regard to what miscarrying women experience in the hospital, which I've often heard described as a nightmare.  When she starts bleeding and/or cramping and goes to the hospital, she often has to wait for many hours in emergency to be seen.  An early loss is not generally considered a medical emergency, but for the parents can definitely be an emotional emergency of epic proportion.  Coping with terror, shock, grief and raw vulnerability as she bleeds and hurts in a room full of people waiting to see a doctor is traumatizing for many women and their partners.

If, during a routine ultrasound it is discovered the little heart has stopped beating, mothers are often given medication to get the process going after a certain amount of time has gone by.  I cannot tell you how many times I have heard women say this was one of the most painful, distressing experiences of their lives.  In my experience a lot of women are not told about this possibility, and suffer not only from the pain itself, but from the terror that something might be terribly terribly wrong with them as they rush to emergency.

Many women these days don't tell people about their early pregnancies, waiting for them to feel more established because they perhaps don't want to have to deal with the often insensitive comments well meaning people might make if the pregnancy miscarries ("it wasn't meant to be" "Nature knows best" "at least it was early"), and the painful explanation she has to make if someone asks how far along she is now.  Others tell people about their new pregnancies right away, not because they are expecting with blind faith all will be well, but because they feel like they would be very open to explaining about their loss and receiving support from their friends, family, and coworkers if loss were to happen.  The point is, these are very personal choices, to be supported without judgement.   

The demands of work and life can press upon women who have had early losses with oppressive force.  Many women grieve profoundly, and are met with a lack of understanding of the depth of their grief. 

I have had several women call me after an early loss who wanted reassurance they were going to be able to go back to work and function normally in a couple of days, worried their grief would overwhelm them and make their productivity at work suffer, thus leading to the potential loss of their job.  The fact that there is a worry about a lack of understanding and a potential penalization for grief over the loss of a pregnancy is saddening.

Everyone has such unique needs and concerns to unburden, all of them valid.  To be able to express them is often more important than any answer the listener can provide.  These women's questions about the length of their grieving and its impact upon their work life were certainly not anything I could answer for them.  To try to have interpreted or shaped their experiences would have been inappropriate. But I could listen as they worked it out themselves, and that seemed to help.

I have experienced more than once a mother who has lost a child at some stage of pregnancy have a strong desire to share, when she felt safe with the people in her presence, an image she had captured of her lifeless baby (whether it looked like a developed baby or not).  I cannot tell you how deeply I have been moved by witnessing a group of women passing around the image, and kissing it with the blessing of loving hearts and mama tears, not looking upon death with shock or  horror, but with honour for that mother for having carried that very child.

In my experience, I have seen some of the most profound healing emerge from within a circle of compassionate women providing peer support for each other.  This is why pregnancy and infant loss support groups can be such powerful resources, which I highly recommend for those who are grieving loss.  

There is a softness which binds us gently together in moments of heart shattering empathy when we come together in community with an intention to heal.  When we trust that all of our feelings are welcome into the circle, courageously expose the soft underbellies of our grief to the loving, listening hearts of those who hold us without judgement, acceptance being mirrored back to us in every pair of eyes we look into, we discover the meaning of grace.

"I tell you this
to break your heart,
by which I mean only
that it break open and never close again
to the rest of the world."
-Mary Oliver

Tuesday, September 29, 2015

Mr. Clean and Me: My Pregnant Love Affair

I am not known across the land for my general housekeeping skills.  Let's just say, I'll never make the cover of "Good Housekeeping"....unless I am pregnant! 

While normally disorganized in the realm of maintaining an orderly home, I'm a total dynamo when I am with child!  

I would get up in the morning when pregnant with my firstborn and have a cleaning schedule that involved dusting, washing base boards, and mopping, things I normally don't pay much attention to until I have to rescue someone who has gotten stuck to my floor.  

I'm not exaggerating when I say that at night while winding down before bed, I would crave the smell and feel of pristine white porcelain.  I'd sneak into my bathroom just to run my hand along the tiles and sink, relishing in the untarnished gleam I'd created by polishing them within an inch of their lives.

Every time I got pregnant, my  husband would say, "Oh, yay, the house is going to be so clean!"

It seems that soon after birth, however, the hormones shift, and housekeeping loses its appeal,  the dust bunnies once again free to reproduce under my bed.

Aside from becoming a bonafide clean freak when pregnant, I developed a bionic nose.  A lot of women report this, but I think mine operated at a startling level.  Even though this is so counter-intuitive for a pregnant person who is supposed to eschew toxic chemicals, I fell madly in love with the smell of cleaning fluids.  Not the fluffy, eco-friendly, gentle-enough-to-eat products.  Oh no.  My nose liked the really harsh ones. 

I could be set off into paroxysms of olfactory bliss by the merest whiff of a floor freshly washed with Mr. Clean.  If I got anywhere near a big ol' soapy bucket full of hot water and cleaning product, I had fantasies of swimming naked in it.  

I knew these products weren't good for me or my baby, so whiffs were guilty little hits I got unintentionally from other peoples' homes.

If our paths had crossed outside of a laundromat, you may have noticed a look of ecstasy on my face and my feet floating above the earth at the sheer bliss of the warm, scented wafts of fabric softener. To my non-pregnant nose, fabric softener reeks of bug spray.  

It wasn't just cleaning products, either, that triggered this scent related glee. 

The bike repair shop owner near my place must have wondered why this very pregnant woman would step into his place of business every day, take several large whiffs, then skulk out sheepishly.  It was the smell of WD40 I was after.  And don't get me started on gas stations!  The tantalizing fragrance of gasoline when we pulled in to fuel up had me bewitched.

As we know, smell is related to how we experience flavour.  When pregnant, it felt like my taste buds were on steroids.  

I use to be a card carrying member of the "I Hate Cilantro" Club.  If there were remnants of the foul green stuff on my food in a restaurant, I couldn't eat it.  Cilantro made me angry. And then my third kid was conceived.  

Like a switch flipping on in the taste centre of my brain, I began to crave the smell and taste of cilantro with a mighty passion.  I couldn't get enough.  I put that stuff in everything.  I wanted to wear it as a necklace so I could smell it and nibble it throughout the day.  Oddly, though giving birth took the edge off my nearly obscene love of cilantro, to this day it remains my favourite culinary herb.

As high as the highs were in my pregnant experiences of smell and taste, the lows were just as intense.  

When I got pregnant with my second kid, before I even knew he was in there, I developed a strong desire to bake my own organic rye bread.  Don't ask me why, I have no idea, but I did.  I went to an organic co-op and bought a bag of rye flakes with the intention of creating magnificent loafs.  

When I got home, I opened the bag to smell it, expecting something tantamount to an olfactory orgasm.  But no!  Like a slap in the face, the smell of the rye flakes triggered a nausea deep within that was practically existential.  I tossed the bag wildly into the cupboard and ran away to hide under the bed covers until my husband came home to remove the offending object. I whimpered pathetically until he assured me it was gone.  

To this very day 21 years later, the mental image of that poor innocent bag of rye sitting forlornly in the cupboard makes me feel ill.

When I was pregnant with kid #4, I discovered a gorgeous white tulip growing in a neighbour's yard.  It was so pretty and inviting, that my pregnant nose couldn't resist going over to sample whatever delectable scent it might have to offer.  I buried my nose in, breathed in deeply... and almost dropped to my knees from the wall of stench that hit me.

That devious little tulip was evil.  I can only describe its smell being as if something had crawled inside it and died.  My family couldn't figure out why I found it so offensive when they smelled it.

Even weirder, was that it smelled SO bad,  I couldn't stop myself from sniffing it every time I walked by, just to reassure myself that it really was as horrific as I had remembered it.

It has been ten years since I've had a baby of my own, but my work as a doula gives me plenty of opportunity to enjoy quirky stories of how pregnancy literally messes with the senses.  

Pregnancy can be weird.  Enjoy!

Tuesday, September 15, 2015

Just had a Baby? Feeling Overwhelmed? A Postpartum Doula Can Help.

It is 4 am.  You have given birth recently, and are still in the process of recovering from that major event.  Feeding your baby isn't easy.  You aren't sure if you're doing things right.  Your baby just doesn't seem to be like the books say.  There is conflicting advice everywhere you turn.  Getting enough to eat is challenging enough, never mind getting the endless laundry done.

Saturday, September 5, 2015

Doulas are not a Luxury "How Doulas Have A Huge, Positive Impact On C-Section Rates"

"What our study showed is that [lower odds of a C-section] don't come with wanting a doula; it's having a doula that is actually associated with important and substantial risk reductions," Kozhimannil said.
The cost of hiring a doula for people without private insurance is often prohibitive. And yet given the on-call time, unpredictable length of time away, skills used, cost of training, materials, childcare, administration etc. that goes into the work, doulas cannot give their services away as a rule and have a sustainable career. They cannot have full time jobs and do this "on the side", given the demands upon availability. It takes a tremendous commitment of time, energy, and money to be a birth worker.
Theses statistics show that doulas are not just a luxury for those who can afford it, but a service that can actually bring healing to an overburdened healthcare system, as well as have a wide reaching positive impact upon the experience of birth. 
How are some ways doula work can become more accessible to all birthing women while respecting our needs for adequate remuneration? 
I am a Canadian doula and this article is American, but it is still relevant.
Awareness of the impact of birth upon new parenthood and beyond also needs to be increased. When people haven't yet gone through birth, they may not know to prioritize the birth experience as something to invest in. How many mothers I speak to, years after birth, tear up and say, "I wish I had known about you when I was having my baby?"
Doulas are underutilized, and the general population of birthing folks who want doulas are under-served.

Wednesday, September 2, 2015

Confessions of a Wildly Successful Doula

My name is Lesley Everest, and I am a wildly successful doula.

Success means different things to different people.  When I speak of success, I don't mean that I've struck it rich and dash off on a private jet to exotic vacation spots whenever I want.  I honour that may sound like success to others, and if that's your definition, awesome!  If that were given to me, I wouldn't say "no".

Success, though, to me, means looking upon the things I have experienced, at the trajectory my future appears to be taking, and being very pleased with what I see.  It is also about knowing that whatever happens, nothing can disturb my peace.

I want it to be clear that I share my success not with any intention to crow about it.  I am not any more special than any other doula out there.  I am no more or less deserving than anyone else. I share this because I want you to feel amazing about your achievements, wherever you are on your path, and honour yourself for all you have done.  It is my hope that by owning your magnificence exactly as you are right now and shining in gratitude for what you already have, you open to the blessings wanting to pour into and out of you.  May this inspire you to walk forward fearlessly on your path.

I became a doula in 1993, having been informally studying midwifery for a year or so.  I was 24.  I had a little daughter.  There was nowhere to train here in Montreal at the time.  As an English speaker from the Canadian Prairies, there was not much available to me educationally within the primarily French speaking province of Quebec.  I can get by in French (shyly and painfully), but my passion for all things birth was so fierce, I wanted to ensure I understood everything clearly.

 I was already a member of La Leche League, on my way to becoming a leader.  The seeds of the immense value inherent in good community support were sown early on my path by my mentors Melissa and Susanna.  These kind, strong, knowledgeable, experienced mothers gently supported my unfolding as I began to shape my path in mama/baby/family care.  To this day I owe my approach of supporting people exactly where they are, not where I think they "should", be to these amazing La Leche League Leaders.

I was very much wanting to become a midwife, and believed doula training would be a great stepping stone towards that goal.  I read in a birth related magazine (I had no computer and had never heard of the Internet at that time) about a doula training that would be happening a few hours travel from me in Boston. I decided to pack up my family (my husband agreed to stay near the training to mind our still breastfeeding toddler) and take the weekend workshop.  Less than a month later, I put out my shingle and began going to births.

Being a La Leche League-er and part of a thriving baby-having and breastfeeding community, I got plenty of opportunity to serve as a doula.  La Leche League has a strong "no advertisement" policy, so I was mindful to not promote my services to anyone within meetings.  But if in private conversation with the pregnant women they asked what I did for a living, I told them.  If they felt like my presence was something that would be helpful to them in labour,  they would call me privately. I volunteered with the Teenage Mother's Association through the YWCA for some of my first few clients as well.  I never advertised my services anywhere.  I would just talk to everyone I met about the work I did, and found people were responsive.  Nobody had ever heard of a doula before where I lived. I was a mother very active in my community, and my presence, combined with my training and growing experience, were my calling cards.  Because I didn't actually have any business cards at the time.

Over the years, I gave birth to more children.  I homeschooled the first two in their early years, and attended births on a small scale.  We had very little money at the time, so doula work was an important part of our income. But being home as much as possible with my kids was a priority.

I immersed myself in education.  Committing to doula work for me meant being able learn all I could.  With breastfeeding little ones, I was fortunate to find continuing education trainings I could bring babies to, or ones that weren't far from my home so I could minimize my time away.  My husband was always supportive of the fact that even though we didn't have a lot to spare, I always reinvested some of my earnings back into education. In fact on weekend intensives he would bring the nurslings to lunch times and breaks.   I knew education was something that would enrich my doula work immeasurably, and was willing to pay for it.  That meant for a few years I barely bought so much as a sock for myself, nor read anything that wasn't a textbook, but given how that has paid off, I don't regret it a bit.

I didn't just want to be a doula, I wanted to bring a healing perspective to what I experienced was a very challenged birth culture.  I wanted to do that one mother, father, and baby at a time by supporting births that made the family feel powerful.  I have always believed Western Medicine is a wonderful thing, but I could see how some of its shadow side sometimes impacted birth in a negative way.

Of course, as a young doula without the benefit of Internet and supportive global connection to wise and experienced doulas back then, I had formed a lot of opinions about what a good birth was.  I only had books and my community's experience to go on.  I was genuinely confused as to why anyone would want to have a baby in a hospital if they were healthy.  It took time, experience, and growth to develop a non-judgmental approach to birth that came from my heart, and wasn't just a slogan in my mind.

I was constantly learning in the early years.  I couldn't get enough.  I still can't! I became an accredited La Leche League Leader, working with my accreditation supervisor through lengthy hand written correspondences, often writing in the wee hours between bouts of tandem nursing.

I studied and certified as a Polarity Therapy Practitioner over a period of 3 years, which is a form of energy based healing that encompasses hands-on bodywork (much of it cranial/sacral based), nutritional support, exercise guidance, and dialoguing with the client about their emotional process throughout the session.   I did a three year professional training in Psychosynthesis Psychotherapy, which is a transpersonal approach to counseling.

I was fascinated with the mind/body connection in birthing!  I also learned about aromatherapy from an Ayurvedic perspective and became obsessed with essential oils, read everything I could about Ayurvedic healing and massage (having learned some massage from Ayurvedic practitioners), and eventually traveled to North Carolina to certify in Pre- and Perinatal Massage with the outstanding Carol Osborne.  I've done workshops in Thai Yoga Massage for Pregnancy and continuing education classes in Cranial/Sacral Therapy.

All the while, I still attended births in the capacity I could given all that was going on with bustling family life.  I had all the births I wanted.  .

Finally, when my third child was old enough to go to Kindergarten, I said, "Okay, Universe.  Let's do this."  I was at this time working with an amazing partner for backup, and things took off.  My partner Rivka and I developed a doula training in response to all the hard ways we had had to learn the ins and outs of doula work on our own due to lacks in our own personal doula trainings.  We made some beautiful magic together. Home computers and Internet were now in most households, and the ability to email revolutionized communication.  Suddenly, I didn't have to search my library of books for answers to questions.  Everything was at my fingertips.

It was at about this time I got my first cell phone.  No more calling my answering machine at home to check my messages from a pay phone every time I was out for more than an hour!  I had a pager, but I learned that it didn't notify me of pages if I was in the Metro.  I got to know where every phone booth in town was, and was always jingling with pockets full of change.

I was so in love with hands on bodywork that I applied to a school of osteopathy in Toronto.  I was accepted, but then found out I was pregnant with baby number 4.  Knowing that monthly travel to Toronto for five days at a time over five years was going to impossible with a new kid, I had to turn down my acceptance.  I was still so pumped to learn more bodywork, so I began my studies in Kinetic Swedish massage locally.  I continued attending births and passed my clinical requirements with flying colours just a couple weeks before I gave birth.  I had to make up classes on occasion because of births taking me away, but my instructors were always very supportive.

I took a short break from doula work to have my baby, and began attending births again as well as continued training Montreal doulas just a few months after birthing my son (I brought him to class with me).  I wasn't happy going to births then, though.  It was hard for me to support other moms and babies when all I wanted to do was be with my baby.  But with a family of six and a mortgage, I had to work.  I remember crying in the bathroom with aching breasts, wanting my baby so much.  It wasn't until he was about 3 years old that I felt okay about leaving him for those long hours.  In spite of my feelings, however, my son thrived with the loving attention from the rest of his family, and he was fine with it.  But if I could do those few years over again, I would have done a shared call service.  There were just not experienced doulas with that kind of availability in town I could have that with at the time.

As the years passed I got busier and busier.  Five year ago I decided that I wanted to end my doula partnership and begin an agency.  I was tired of turning so much business away because I was only one person with a handful of backups, so I figured I would build a community of doulas and be able to have a wider reach of service, as well as receive a percentage of the revenue I dispatched to others.  I didn't know of any other agencies at the time.

What I realize now was that births were becoming more plentiful because my partner and I had been training more doulas, and they were going out into the world and spreading the message, getting the word out.  The more trained doulas there were, the more work was coming in.  The Internet also was a great help to the promotion of doula work.

My friend Sue had done a standard two day doula training and had found it great in many ways, but lacking in others.  She is delightfully straightforward, and told me that she had a large gorgeous home to provide, and that she wanted to learn from me and would do whatever it took to make that happen.  I took the elements of the doula training I had previously taught that were of my creation, and from there birthed a whole new training.  It was retreat style.  For six days and nights we talked, ate, and slept birth.  The attendees affectionately called it doula camp.  The women in the training inspired me to get my agency going in a very real way, to organize, and to bring bring my now years of experience to the world.  They had so much to give, and I wanted to make sure they could do so with good return.

In November 2010, I plucked the willing ladies with whom I felt a deep connection and added them to a couple of amazing women I had trained in the past who were interested in working with me. I found a loft space for us as a headquarters, and MotherWit was officially born.  I have used the MotherWit name for my own personal business for most of my career, but now it was an

It has been almost five years we've been together, losing and gaining a few members along the way, and I am so very proud of us!

I took several doulas with little to no hands-on experience and built the doula community I wanted to see.  Within not even five years, our little MotherWit Doula Care company has attended around 700 births.  We are a linguistic minority, serving mostly the English speaking population of Montreal, so our client pool is quite small.  When I say we have attended 700 births, I am not including the hundreds I attended prior to the forming of MotherWit.  I am also not including the volunteer births that have been referred to my apprentice doulas through organizations who take care of pregnant families in true need.  I mean 700 paying MotherWit Doula Care clients attended doula-style, with continual labour support with our typical pre/postnatal support meetings.

My Birth Essentials Pre-Natal Classes took off quickly, and fill up most months.  We've taught over 500 people our course in childbirth empowerment.  A large percentage of our students come from physician referral.  We also run a Mom's Meetup group, which our clients love.

MotherWit Doula Care hosts a monthly doula gathering, open to any doula from any organization who wants to join in, for an evening of birth story sharing, wine, and sisterhood.
 We are even joined on occasion by medical folks who want a hit of that kind of camaraderie.  One day Gloria Lemay joined us for an impromptu film showing.  Another time Gena Kirby came to hang out.

I have taught Holistic Birth Doula Trainings and accompanied MotherWit Birth and Postpartum Doula Extraordinaire Millie Tresierra to Holistic Postpartum Doula Trainings in cities in Canada.  I have personally brought around one hundred apprentices to births.

I have brought my "Soft Skills for Medical Professionals" workshop to several hundred McGill nursing students, and have taught groups of new nurses doula skills in their hospital.  I have taught workshops to medical residents and family physicians on various aspects of comfort measures for labouring women.  Some have come up to me years later to say, "What you said changed my life."  I don't take that personally, as I didn't tell them anything I invented (I didn't create Birth).  I just told them stuff their trainings didn't.  I didn't go out trying to get this to happen.  They invited me, and continue to do so.

I have traveled to Madagascar with a midwife and doctor friend at the request of dear former clients of mine, doing educational exchanges with indigenous Rain Forest Midwives, sleeping in tents miles away from the nearest road or "civilization".  I have experienced the uterine massage the midwives do to heal infertility, have tasted the herb dingadingana they use to stop postpartum bleeding, saw the smallest baby I've ever seen outside an NICU, and so many more things that would be a book in and of itself.

I have been to quite a few conferences, and recently was a presenter at the last Birth and Beyond Conference.  That was pretty amazing, as I had a one on one breakfast with Ina May Gaskin, champagne with Dr. James McKenna, and lively dinner discussion with Dr. Jack Newman.  I am a total unknown from Canada, so these are special moments I hold very dear.  I have learned so much from these people and their bodies of work, and I was in fan girl heaven to pick their brains and listen to their stories.

I have worked REALLY hard to not only have people receive the benefits of doula care, but to create a community for doulas to be supported within, creating good education and a strong self care ethic for those who are crazy enough to want to be doulas.  I am prone to overwork, and have been known to work through times of not feeling my best.  This has caught up with me at times.

When I learned how truly successful I was had little to do with my bank account, the sixty plus births a year I personally attended, the hours of professional trainings under my belt, the many students I put on the path of birth, the success of my childbirth education class, the medical professional teachings I did, or any of that.  It came when, three years ago, I was diagnosed with cancer.

It wasn't just dysplasia or lump that could be taken out.  I had invasive cervical cancer that had grown through my pelvic walls, was compressing both of my ureters and cutting off my kidney function.  I was hemorrhaging dangerously, and I was in renal failure.  I had to get tubes inserted into my kidneys and wear these not so sexy pee collection bags strapped to my legs for months at a time.  The prognosis was bleak.

When I announced my illness with a sense of sorrow and even shame (yes, I felt ashamed that I was being a burden...not good), this is when I was smacked in the face with what true success meant. I cannot even describe the outpouring of love, prayers, gifts, vigils, food, and good wishes that came my way.  My friends, spiritual community, and global doula family were powerful allies in my healing process. My MotherWit team took over the doula trainings I had scheduled.  They took over my many clients in addition to their own busy schedules.  They did this without any expectation of payment.  I tear up even just writing about it.  My agency revenue helped to support my family while I couldn't actively doula, and was so grateful for the doula prosperity I had established.

When I was gravely ill, in terrible pain, zonked on morphine, sick from radiation, achy boned from chemo, bedridden, worried about a loss of income and terrified for my very life, to have kind eyes to look into, to know my family was being helped, to know that so many beloveds had my back, is worth more than anything I can even describe.

I have many daily affirmations, but this one I hold dearest to my heart: "I am motivated only by love."  Things tend to take care of themselves with that.  If you're skeptical about love putting food on the table, know that this motivation is largely responsible for the fact that my doula work has evolved as it has, not through SEO  (I didn't even know what that meant until a year ago), or spending money on branding (though I know love AND these things have helped other people, so yay!  I'm just talking about me, here.).  I commit to giving the best service I can.  The best advertisement is a job profoundly well done with a wonderful attitude towards all involved.  It is like passing out 100 business cards, as satisfied customers rave about you.

I am not motivated by any desire for power.  I have no desire to dominate anything.  That would take far too much work and stress, and then I wouldn't have time to do the brunch/spa dates that are so important to me and my team for self-care.  Besides, power driven dreams are the machinations of Ego, and don't speak to the heart of service, which is what the healing of this birth culture requires.  When I meet prospective clients, I don't go into the meeting only selling myself.  I see myself promoting "the work" and all the doulas who do it.  The desire to dominate is what has created much of the world's suffering.  Prosper and thrive, though, YES!

My motivation isn't to be stinko rich.  I am crazy wealthy compared to most people on our beloved Earth.  I can barely keep the little house I have organized.  Why would I need something bigger for a family who is growing and moving out?  My garden is beautiful, and that is what makes me happy. Food is plentiful, shelter is good, and we have everything we need.

"I am motivated only by love."  So when I felt overwhelmed by the tsunami of love that flowed my way when I was sick, there was always a hand that would grab mine and a voice to say, "all the love you have put out, is coming back to you in your time of need."  I heard those words from people several times per day.  It can be HARD to rub all that concentrated goodness into your heart when you have spent time in the the cancer wards as a patient, been to Third World countries, and know others in the world are suffering terribly.  But I did.  I breathed the love in.  I dared to own it.  I drew it into all my cells consciously, and I swear, combined with the good Western Medicine, the healing ceremonies my dear friend Nat made sure to get me to, visits with spiritual healers, and the love of my doula sisters and clients from around the world,  I dug deep and I HEALED!

When my body's wellness caught up to my strong spirit, I went back to doula work, but gently, jut to keep my finger on the pulse of the living work.  I will no longer do more than twenty births per year, just to keep my feet in.  I like the idea of childbirth educators and doula trainers being actively connected to the work.  Before illness I had made great money going to a lot of births and having a crazy teaching schedule.  But no amount of money was worth what I put my body and my family through.  

I take more time off now.  My team and I went to Vegas last year on an enforced doula holiday, leaving our clients in the hands of very capable doula backups.  Nobody gave birth while we were away, however, which is weird, because one of us is always at a birth.  But for those of you in the know, it's how Birth often rolls.

When I got well I also knew I had to continue to give back all that beautiful love.  To make a long story short, at the behest of  many persistent dreams, I joined the One Spirit Interfaith/Interspiritual Seminary in New York City.  Before the post cancer treatment PET scan was even clear, I knew I wanted to become an interspiritual minister (I am not religious, but spiritual) to help all people (not just birthing and parenting people) find their connection to their own inner wisdom (motherwit).  After two years of study (in person sometimes and through distance learning), my ordination was celebrated at the Riverside Church in Manhattan.  My MotherWit Doula Care team joined me in New York City to celebrate.  Not just my Montreal crew, but also former team members who had moved across the continent.  We had a BLAST.

During my seminary training, I learned to volunteer in patient care in hospice, participating with those about to leave this life.  I love end of life care, and will continue to develop my skills in that area.  Holding the space for dying has become as moving as holding the space for birthing.

I have studied and become a Shamanic Reiki Master Practitioner with the amazing Llyne Roberts at the Omega Institute in Rhinebeck, NY.  This has brought my work with birthing families and doula training to another level.

I have really enjoyed watching doulas become more business minded as years go by, and seeing doula work growing into a more substantial and sustainable profession.  I have always ensured that my trainings gave the solid foundation to the product being sold, for the sake of the buyers and the doulas themselves.  It is good that doulas can take their service and sell it with integrity with all of the tools and business insights/trainings that are now available.  And I always encourage mindfulness about not allowing the product (your service) to overwhelm the product capacity (your own energy).  Because if you burn out, that is one less person doing the good work.  That hurts all of us.

Business continues to grow.

One of my favourite aspects of growth is that MotherWit is now our family business.  My husband Mitchell is a vital part of the organization.  He gets overlooked a lot, because he's very behind the scenes.  There is a beautiful poem by Margaret Atwood called "Variations on the Word Sleep".  There is a line that says, "I would like to be the air that inhabits you for a moment only.  I would like to be that unnoticed and that necessary." This is how my dear, humble Mitchell, my rock for over 25 years, operates.  He stays home and keeps the running of things as smooth as possible.  He points me in the direction I need to go and I go.  I am so busy mothering, doula-ing, teaching, talking to people, and writing content for classes and manuals, dealing with students, pursuing studies, etc., that I can't run this ship on my own. Without Mitchell, I couldn't be doing what I'm doing.  If you ever think of MotherWit, send my husband a loving thought.

I have learned a lot about promotion and organization over the years.  This old dog definitely has learned new tricks, but there are bandwagons I haven't jumped on, though if they work for you, more power to you!  Telling you what I do or don't do is in no way a judgement of what you yourself are implementing in your business.  We need all approaches, and I thank all of those who seek to have doulas empowered to own their worth and support their families doing what they love. You are bringing healing.

At MotherWit, we don't, for example, hand out information packages to prospective clients.  I'm an old hippy, I used cloth diapers for my kids.  I just don't want to spend the time and money creating these things, though I think they could be valuable for newer doulas who haven't yet established a reputation in their communities.  My team is adamant about not wanting to put time limits on birthing clients or doing shared care.  Not because it's not okay to do those things if you want but because we generally really love our work and our clients, and are experienced enough at pacing to not find ourselves at super long births very often.  Plus, none of us have kids under double digits, so it works for us. We are in for a penny, in for a pound.  But we also know that we can rely on a colleague whom the client has met to relieve us of doula duty if we are over-tired or our families need us.  Nobody needs to overextend themselves.

I don't have a target market.  If you want a doula, you're nice, we speak the same language, and you value what I have to offer, you're welcome to purchase my birth doula services.  I fully believe that I don't have to have any kind of crafty edge to seal any deals.  It is my doula service someone is buying,  that which comes from my hands, my eyes, my words, and my heart, not any kind of concept.  A pregnant mother/couple wants to feel safe and cared for by someone they click with.  I will never force a "click" because I need to hustle for money.  I trust that if on the odd occasion it doesn't feel like a great fit, another doula will take that place, and that is wonderful.  Another door will open for me. Because every time a client finds the doula of her dreams, that is ALL of our success.  The more doulas there are out there in my town, the more people will know about us and the 90 per cent or so of people who don't really know much about doulas will be tapped into, and hey, that's great for EVERYONE!  I have seen this principle in action over the years.

I believe in good business ethics.  Don't tear other people down.  Don't get sucked into drama.  If you're so worried about other peoples' business, who's minding your own? If you make a mistake with your client or a colleague,  learn from it and make sure nobody falls through the cracks again.  And for Pete's sake, be original! Create your own ideas and formats. Obviously, there is nothing new under the sun, and customs do develop in doula business, which is fine.  But work them your own way. You have it in you! Let's not take cookie cutter approaches to something as huge, mysterious, and awesome as birth support.

We all struggle with Ego and rub up against fear that there is threat to our livelihood, or that someone else is getting more than we are.  I still find myself there on occasion.  We are human.  It's gonna happen. Breathe.  Relax.  Let it go. There is more than enough to go around and room for everyone to shine.  Let your competition's success be a victory in your own heart, and wish them the good things they deserve on this crazy doula path. Trust.  May the seeds you sow with your hard work and nourish with your love and care bloom into an ethical practice of integrity and wild success.  Only that will truly nourish your work and life in a real and sustainable way.  It may sound hokey, but I really do believe that an open heart allows prosperity to flow to us more easily than one that is shut down in fear or is motivated by egoic concerns.

I am blessed after a long career to have made close acquaintances with medical caregivers (even having attended some of their births).  Some of them have become dear friends.  The great thing
about having conversations about birth over cocktails with a friend is that you gain a deeper understanding of their perspective.  You are so proud of them for what they've accomplished, and hear their challenges with much compassion.  Your faith that women in birth CAN have it all when a bunch of loving people from different paths come together is bolstered.

When I say I am wildly successful, I mean that on a physical level, I have all I need and more.  I am rich in story, rich in experience, rich in love.  In every moment, as my beloved mentor Frank teaches me,  I can ground myself in the goodness of my many blessings.  I can put my hands on the sacred Earth, stretch my arms into the vastness of the sky, drawing in energy, breathing out love and blessings,  and say, "I am WELL, I am ENERGIZED, and it is a GOOD day to be alive!"  Not feeling that way?  Say it anyway!  Continue to say it until it is true.  Don't like the vibe of the birth community in your town?  Don't like how your practice is going? Be the change you want to see!  Don't listen to me, do what your own gut says.  You have a path.  Walk it the way that works for you.

 May you only be motivated by love, and then do the hard work with fire in your belly to bring the healing our service provides.  The prosperity tends to follow if you deeply value YOU.  It isn't easy to grow and sustain a thriving doula practice, but as a very wise Grandmother once told me, "If it is FOR you, it will not go BY you."

The only thing you take with you when you go, Dear Ones, is love.  Trust me, I've seen it in the eyes of the dying.  The love and peace you feel going out is often about how much love you've put in. So be generous with your loving.  I have seen it come back to me a thousandfold.  Have good boundaries, of course.  Give your love freely, but get paid well for the services you provide, though trust those times your intuition tells you to give your service away to someone. If this is true intuition talking, this will not happen more than you can handle. Don't be attached to the results of your heart felt efforts(because we can only influence, not control), take great care of YOU, remember why you're doing this in the first place, learn from the hard experiences, and ENJOY the ride.  But most of all, love with no questions asked.  That is the secret to a wildly successful life.

May you doula in all your glory!  You are beautiful.  Learn it.  Live it.  Love it.