Friday, December 4, 2009

Why I'm a Doula

I get asked all the time why I've decided to just stay a doula instead of pursue a career in midwifery. I get asked this as if doula work is only a stepping stone to something better, or as if there is greater glory in becoming a baby catcher. But the truth is, I love being a doula. I have witnessed hundreds of births in the last 16 years, almost all of them from a completely non-clinical perspective. This gives me a lot of freedom to develop a unique set of observational skills not many have.

I used to want to be a midwife. I did study midwifery with near religious fervor, forming and working hard in study groups, helping midwives at friends' birthings, taking skills workshops with midwives, and my doula training, which was actually a midwifery assistant's training at the time....not anything DONA would have approved of, that's for sure. I wanted to get some doula skills under my belt, and thought the opportunity to get to more births, even in the hospital, would provide the stepping stones I needed to advance my midwifery studies. Meanwhile, I researched study options in England and the Netherlands, though with a growing family and university options not being very supportive of mothers with young, tandem nursing children nor International moves being affordable, I wasn't sure what to do.

I am an absolute supporter of home birth. 3 of my 4 babies were born at home, one unassisted, and one with a family doctor and midwife at a hospital, because he was on the early side, and the labour was difficult. I was only there for a couple hours before he was born naturally. For any woman who seems like she would be open to it, I suggest she explore home birth as a potential option. I love going to home births and births at midwife run birthing centres, as they give me little hits of sanity and nurture my mental health.

So why do I stick with a mostly hospital birth doula practice when my roots are in home birth and aspiring midwifery?

This is why: I was a doula about 11 years ago for an amazing single mom. Her husband had walked out on her after a 10 year relationship because the pregnancy was unplanned and he was not ready to be a father. He blamed her for keeping the pregnancy, which was very much wanted by her. So he left when she was about 8 or 8.5 months along. She wasn't from my town (or country, for that matter), and her family wasn't around. She really didn't have anyone to talk to or to grieve with, so I gave her everything I could in terms of emotional support, making sure she had what she needed to give birth. She was a tough lady. Her waters broke quite awhile before labour started, and she decided to go to the hospital because that's what her doctor told her to do. We went, and she quickly went into normal labour. But not quickly enough for her doctor, who basically threatened her with the possible death of her baby if she did not receive Synto (Pit for you Americans). She realized what kind of fear mongering was possible, and decided to do her own thing. The long and short of it was that she had a natural birth, even though the father showed up at the hospital, claiming his right to be there because it was his baby!!!!!

After she birthed her boy, she began bleeding dangerously. All the staff in the room jumped in to get it under control, even the nice nurse who was helping with a lot of labour support. Everyone had to get really clinical, really fast, and that was a good thing, because their work prevented a bleed that could have left her extremely weak for a long time, which is not a great situation for early motherhood, especially when you don't have a lot of help. Anyway, while everyone was on the business end of her, she and I were head to head, me standing, her in the bed, adoring her beautiful new son in his first moments of life. Instead of putting my interest into the clinical management of postpartum haemorrhage, I just hung out with her, witnessing this precious moment with her. She turned to me, her eyes shining like I have never seen eyes shine before. They were full of a love that was positively holy. "Oh, I love him...I LOVE him!" she whispered in the most awestruck voice. And then it hit me with absolute clarity...THIS was the role I wanted to play in birth. Had I not been available to tenderly hold this new mother's moment of glory because I was managing her bleeding, the utterance of those sacred words of the purest love and the look in those eyes would have gone unheard and unseen. And that would have been very sad, because after all she had been through, the connection to another being who understood the depth of those feelings and all she had gone through to get there, provided her with healing.

Do I wish way more women felt safe enough and had enough faith in their bodies to give birth in a non medical environment? Sure! Does it make it so just because I wish it? NO! Look, the truth is that the vast majority of North American women feel safest in a hospital to give birth, willing to accept the intervention-heavy environment for the sense of security medical professionals and equipment provide, whether that's always true or not. So if this is the place most women are birthing, this is where I want to be. I want to provide continuity of care when shifts change. I want to create a sense of trust in her body, and buffer the environment for her which always seeks to draw her out of her focus and use her spaces for their need for information. Where care is clinical, I want to provide nurturing, to the mother, her partner, and the baby. Both roles, the clinical and the nurturing, are important to the potential for the happiest outcome.

I've let go of my midwifery calling. Midwives are doing a fabulous job providing loving, nurturing clinical care to those ladies who choose to birth with them, and I am so grateful for them. So I continue to focus on creating gentler births for those who choose the hospital, as every mom, partner, and baby need to feel like someone is aware of and willing to meet their emotional needs. Because I spend so much time prenatally building rapport with my clients, I understand what they want, what they're afraid of, what traumas they have, how they perceive stress and pain. I can make them feel secure in knowing their needs for comfort will be met. So this way, they truly feel they have the best of both worlds: good clinical care, and constant, familiar, nurturing, hands- on support.

Having a natural birth in a hospital is very difficult. I try to make it a bit easier. And I think it works. In my neck of the woods, the epidural rate is 98% for first time mothers. For my clients, it is less than 50% total, and this includes people who knew they wanted one, people who had complications (I include a really stressful environment we really couldn't manage a complication), etc. For those women who were dedicated to having a natural birth and had normal births, that rate goes down to 10%.

A good doula, one who knows how to use respect and diplomacy in the hospital, will make a difference. She not only supports the couple, but the staff feel relaxed and supported as well. We know we can't interfere with the way things are run...it's a big system, and trying to approach it in a Quixotic way will only do more harm to the ladies in our care than good... but we can draw compassion from those who run it, with kindness, diplomacy, and non-judgment, which helps create an atmosphere more conducive to birthing normally. Respect is our most valueable Medicine in that environment.

A midwife I know once told me I am humble for doing the job I do. But I don't feel that way, as it implies I'm maybe just sucking up doing something yucky. I just feel honoured. If a lady barfs all over herself in labour, it truly makes me feel good to help clean her up and make her more comfortable. Making sure she feels no shame about it is so important, and to me that's very honourable work. When my friend Nat, who just gave birth a year ago, is getting ready to go outside and her baby Iggy is in a sling close to her body, I'll put her shoes on for her so she doesn't have to bend over uncomfortably. This is what everyone should do for mothers. I don't feel like a "servant", I feel like I'm helping mothers save their energy for the important work of nurturing their babies. The doulas I know don't see themselves as beneath anybody because we wipe bums or shlep suitcases for couples checking into the hospital to give birth. We feel really great about what we do. When it's 6am and I'm coming home from a birth on the Metro and I see everyone going to their jobs, I am so thankful for what I do, as I witness the beginning of life...the life of a person, the life of a new family, who are thriving in part because of my care for them. I feel like a rock star.


Have a wonderful weekend, Gentle Readers. I'll be back next week.