Tuesday, December 28, 2010

Birth Stats: A Doula's Year in Review

I just got home from an absolutely gorgeous birth of a nice big boy. This is most likely my last birth before the new year, though anything is possible. As I have time to do so now, I'll share how things went this year.

Before getting to the birth stats, let me just say this has been a HUGE year for me, full of growth. Though I have been a doula for quite some time, MotherWit is just over a year old. In this year I created and we launched our very successful Birth Essentials: A Course in Childbirth Empowerment prenatal classes. I taught my birth doula training in intensive format for the first time with great success. I also taught for the first time a four day postpartum doula training course. Both trainings required many hours of creation and hundreds of pages of doula training manual writing. The work was well worth all the effort, and I am very very pleased with my amazing apprentices and students.

The MotherWit team opened a physical space, something we had been hoping to do for quite some time. In this space we teach our classes, see our clients, do trainings, have mom/baby groups, apprentice meetings, "Meet the Doula" soirees, and will soon be doing infant massage teaching for parents. We have parties, too. I am thrilled with our cozy space.

MotherWit was asked to do 2 informal, in- hospital doula-led workshops...one 8 hour workshop for new nurses, and one 1 hour workshop for family medicine residents. Oh, what fun! This was a very eye opening endeavour, and we learned a lot about where many medical people's hearts are at...it was all good news. We also learned about how restrictive protocols and policies can be and how they inhibit some of the ways some of these people really wish they could work. There is lots of exciting work to do in these areas to create more satisfactory birth experiences for families who want/need to birth in a hospital. Working together, I truly believe good changes can be made. People often think I'm a PollyAnna and a dimwit for holding onto that hope. But I stand by it. Yes, I am myself a home birther. Yes, I point women who want to take that route to all the resources available whenever it seems they want this option. Yes, I sometimes feel I am being asked to witness train wrecks. Yes, sometimes what happens in hospitals is terribly hurtful and frustrating. But as MOST women are still wanting to birth in the hospital because this is where they feel safest, I feel focusing my energies on ensuring these potentially overly managed births, often the price for this sense of safety, have a lot of input from well informed, well prepared parents. I also feel it is crucial for these women and men to have emotional buffering when necessary. Everyone deserves support in labour, to have their choices honoured, and to feel heard and loved. This is the essence of doula work.

I also went to Madagascar this year! Yes, I am still intending to blog about this experience, but as you can see, work has been crazy! I will get there. It was incredible! The preparation to get this trip underway was no easy feat, and it took a lot of time and energy, again, well worth the effort.

On a personal note, my eldest baby turned 18 and my youngest baby started Kindergarten this year. My sisters came from the UK to visit because one of them got married here in Quebec...a truly lovely wedding. My mom and stepfather had some health challenges that are now, thank Goodness, behind them (ptu ptu ptu). It felt like a real blessing to have Christmas together with everyone in good health. I lost my friend Lhasa to breast cancer early this year. If it taught me anything, it was to seize opportunities and to be very grateful for every day.

I attended 42 births this year and saw 47 babies enter into this world. This is, thank Goodness, 21 births less than I attended last year. My goal had been to attend much less births. While 42 births is still a ton given everything else I've been doing, it was technically still a bit of an easier year in terms of birth attending. I am so glad for the MotherWit team who are slowly beginning to take over the volume of births I'm trying to let go of little by little. My goal is to do significantly less this year so I can focus on teaching, as I have been receiving requests from different places to train doulas. I also REALLY want to finish my book. I had hoped it would have been done this year, but not yet.

Many people think doulas have good stats because we attract couples who want natural births. This is so not always the case. As doula work becomes more mainstream, it is not necessarily those who are hoping for a natural birth who seek out our services. Often it's couples who are savvy of how lost they may become within the hospital system, and just really want an anchor, or to ensure there will be someone there to trust them and give them support when they feel afraid. As I said, everyone deserves support in childbirth, not just those who have the goal of natural childbirth in mind.

The main demographic of my clients are educated middle to upper class couples. They are of varying races, religions, and sexual orientation. While having a large percentage of educated, prosperous couples as clients may sound easy, I assure you this is not often the case. Many of these couples come to birth having been very focused on careers up 'til this point, and are educated about birth via friends (who love to share horror stories), media, and their doctors. The connection they forge with their bodies and their emotional needs as soon to be parents (with our guidance) is often very new. Our way of helping couples prepare for birth is less intellectual and more about encouraging them NOT to trust a clock or a number, but to tune into themselves. It is not easy encouraging women who have spent all their lives in control of things to let go and allow this primal process to unfold organically. They often refer to "those other ladies" who can squat in the fields, not realizing that they are capable of that too. Their doctors also often assume that because they are educated and career oriented that they will be thrilled with the "civilized" way of birth (induction and epidural), so it's often promoted as a good thing for them. One of my clients was offered a planned Cesarean (not often done in Quebec at all), probably simply because she comes from a very wealthy family, and it was assumed (wrongly) that she would feel too posh to push. Believe me, we have our work cut out for us to help women connect to those fledgling, barely whispered of hopes they hold that maybe they could have births like the women in those documentaries, even if they're not planning to give birth at home in a kiddie pool but with a high risk obstetrician at a tertiery care hospital because they're on the long toothed side of 35, and in spite of the fact they are getting most of their childbirth education from a culture who looks to A Baby Story for inspiration. To those of you who really know birth, I know this sounds like an impossible dream. But I am telling you, even though they're not birthing in pools, they are getting to places they never thought they'd go, and these ladies who are often told by their friends and doctors that they WILL be begging for "their" epidurals (as if there's one just waiting to scoop up every birthing woman) as soon as the going gets really tough, ARE BIRTHING NATURALLY! With doulas, anyway. Yes, we still see way more epidurals and Cesareans than we otherwise would if most of these women planned to give birth at home, but substantially more than half of my mamas birthed naturally this year.

Out of these 42 births, only 2 this year were planned outside of a hospital (both were planned at a Maison de Naissance, or Birth House for those of you who don't speak French or Frenglish, which is a free standing birthing clinic run by midwives...no doctors on staff). One lady was transferred from there to the hospital to give birth, and another gave birth so quickly her midwife barely had time to run to her house to catch her baby. All of the rest happened in hospitals. In the downtown Montreal area, hospital birthing women have up to 98% epidural rates, meaning about 2% of first time mothers here birth without epidural. According to nurses, most of those women wanted an epidural, but didn't get it on time. Midwives do not make up hospital staff here. All of these births were attended by doctors.

I had a higher percentage than usual of Cesarean births this year. So, in total, 7 surgical births: 1 planned for twins because both were breech (the doctor on call said he would attempt to assist with a vaginal birth, but the mother chose otherwise), 1 planned for twins because one twin was definitely showing signs of distress before labour had even begun, 1 mom induced with 41 week twins (after 36 hours of labour, things didn't progress), 1 singleton birth planned at 37 weeks for vasa previa, 1 attempted singleton VBAC attempting lady had a repeat C-section for fetal distress due to an abrupted placenta (they thought maybe the uterus had ruptured), 1 planned for twins with a pre-ecclamptic mom with a breech first baby, and one long singleton labour that ended with fetal distress and an emergency Cesarean. All babies were born healthy, or became healthy quickly after birth. This is just shy of a 17 per cent Csection rate, which is the WORST I've ever had. As you can see, the majority of these surgical births involved twins. There is SO much work to be done to support twin moms, who are subject to a crazy amount of intervention.

8 of my ladies had epidurals (the ladies who had Csections only had epidurals at the very end of labour because they knew they were going to have surgery, or were planned, so I don't count them in this stat). 3 were for long, hard posterior labours, 2 were for Cervidil/Pit induced labours, one lady got one at 8cm after her Cervix hadn't changed after 1.5 hours with transition contractions...wasn't attached to natural birth, , and two wanted them when labour started getting really tough because they had both had traumatic birth experiences before and were terrified of experiencing that level of pain for a long time again. They felt it was what they needed to feel safe. Epidural rate, 19%

27 of my clients experienced natural birth. Some were "augmented" because of waters being broken for a long time before labour starting, but they gave birth without epidural or IV narcotics.

Out of these natural births 11 were first time moms (one mom of twins in there), 3 were VBACS, and the rest (13) were subsequent vaginal births, most second and a couple of third babies. 64% natural births.

So, folks, that's this doula's year in review. I cannot thank those enough who had me at their births, and to all those who have helped and supported MotherWit get off the ground. You are all appreciated.

I will leave you with a nice story. I encountered a lovely resident at the hospital today who told me she had been one of the residents to attend the workshop I gave earlier this year. She told me this workshop had really touched her, and that it had been exciting and eye opening. After my client gave birth with her usual beautiful grace, on her hands and knees with her husband helping, and she and her husband and baby had had some time to bond and bask in the glory of their experience for a while, the resident came up to them and said with her eyes shining, "Thank you so much for the honour of sharing in such a special time in your life." The message I really tried to give to the residents was to remember this...that no matter how many births they attend, no matter how interesting of a "case" it may be, these patients of theirs are bringing life into the world, and that it is sacred and special. I emphasized that if those patients will remember anything about the people who were involved with their births, it will be how honouring their caregivers were of them. It was really moving to see this resident not only act as if were not just an ordinary part of her day, but to express the sacredness of their experience with her gratitude. May this trend continue....

Happy New Year!