Wednesday, December 30, 2009

Happy New Year!

I wish all of you a beautiful New Year, full of love, health, joy, abundance, and discovery! I will be back soon!

Love,
Lesley

Wednesday, December 23, 2009

mentoring

I had a lovely meeting with my partner-in-crime, the lovely Sue Appleton of Apple of Your Eye Doula Services in St. John, NB. She is facilitating the Summer 2010 MotherWit Birth Doula Training Intensive that I will be teaching in Morin Heights, Quebec.

I believe very much in apprenticeship for a student doula. I have been happily apprenticing students for 6 or 7 years. It is by shadowing an experienced doula a student learns how to be at births...when there is no pressure to do anything but observe and do what's asked by the doula, much is learned. Because my training is in intensive format meant to be taken on the road to whomever would like to host it, I cannot personally provide apprenticeship to all my students. But I would like to.

What I will be doing is creating a MotherWit Birth Doula Mentorship weekend workshop. It will be for any doula, no matter her training, who has attended at least 30 documented births. This workshop will bridge the gaps between my training and other trainings, and provide instruction on how to effectively mentor a novice MotherWit trained doula through her first births. Mentorship trainees will learn about how to draw out the strengths of her apprentice, provide constructive criticism, how to guide her towards improving her skills , and show her the ropes of the birthing centres in her area.

Essentially, the mentor "doulas" the novice doula as she finds her way as a birth attendant. While a doula mothers the mother, the job as mentor is to be a "big sister". The average amount for a mentor to be paid for a 2 or 3 birth apprenticeship is anywhere from $300 to $600, depending upon the doula's availability and experience.

In my experience, having an extra set of hands from a willing apprentice and someone to chat with and bounce ideas off is a fun and rewarding. I love seeing a doula really come into her own as she gets to use what she's learned to help a woman birth.

Check early January 2010 for more details on motherwit.ca

Tuesday, December 22, 2009

Off Call

Whoohoo! As of tonight until the night of the 26th, I am completely off call!!!!! This is a rare occurrence, and I am revelling in the idea of being able to sleep deeply not caring where my phone is. I leave any potential early birthers in the good hands of my doula buddy Rivka.

I am going to focus on my family and working on my poor, neglected website. Maybe I'll even get the house clean! In any case, a little time off call once in awhile is an important thing.

Okay, off to watch The Grinch!

Monday, December 21, 2009

Happy Solstice!

Hooray! The sun is once again reborn, and the days will become longer. As we enter into the birth of the light, let's take a moment to be grateful for this amazing momentum we advocates of normal birth are building to help heal the long dark age of unconsciousness surrounding women's wisdom. We are at such a peak of insanity with planned C-sections for convenience, anaesthetised labour, being told SO MANY times we are defunct in our brilliant ability to express our most unique female function, there HAS to be a shift. There is an incredible global network of folks working hard to create a new paradigm in which our bodies are viewed as trustworthy vessels to do their work the way Nature intended.

This is in no way to say we should all just birth in the woods. I personally might, as would many I know...but I do not eschew technological advance in its ability to help promote safety in childbirth...when appropriate. I have seen friends and clients unexpectedly but truly need to rely on some interventions for their and their babies' well being. Though we may begrudge the environment of birth for mainly being technocratic and mistrustful of womens' sacred functions, I feel that adopting an attitude of "us against them" heals nobody. Whether we shoot from the left or shoot from the right, the very act of shooting can be potentially ugly. If only we could all have respect and honour for each other, based upon true understanding and basic trust, we could have far better birth outcomes than we do. Ah, but that just isn't going to happen for awhile. Just because I wish it, will not make it so. But I work towards that time.

I LOVE working with a woman in a hospital and seeing a medical person learn something they didn't know about the more emotional/spiritual/psychological aspects of childbirth, or see them deeply moved by a natural labour. These stories create change. If they only happened at home, the very people whose eyes we're trying to open might just remain in the dark about the possibilities. If they didn't see empowered, beautiful births in person within their environment, often facilitated by a doula or midwife, seeds of real awakening might no come about. So I feel so happy to be living my path, trying to create an awareness of birth as something beyond a series of phases and stages that needs management.

Medically managed birth as the cultural norm is not going anywhere for a long while. So I am choosing to bring the love into this environment, helping women, helping their doctors, finding balance. From a place of greater understanding among all, we can create more respectful and effective diaglogue.

There are many ways to bring in the light. Blessings to the radical midwives! Blessings to uc-ers! Blessings to doctors with the hearts and hands of midwives! Blessings to the water birthers and dolphin midwives! Blessings to high risk obstetricians who use their skills for the greatest good! Blessings to the lotus birthers! Blessings to the baby wearing, breastfeeding-til-5, co-sleeping, homeschooling mamas! Blessings to med students slogging over their books, thinking birth is kinda gross...may a beautiful hospital birth open their eyes to never before considered possibilities that were never mentioned in those books! And bless my doula sisters everywhere, who are willing to witness and hold.

May the seeds of our good intentions flourish in the light.

So mote it be.

Friday, December 18, 2009

Holidays

Phew, it's brutal out there! It is freezing cold outside and we have been doing lots of Christmas shopping. Thank goodness we're home, warm, and dry. It's so nice to relax on Friday nights and know I don't have to get up early Saturday morning to get the kids off to where they need to go, then have appointments all day. Ahh, sleeping in is the best!

May you all have a lovely weekend! Try to get some rest, stay warm, and enjoy the holiday season.

Thursday, December 17, 2009

Empowering Nurses

I had a great meeting today at a hospital I spend a lot of time doing labour support at. I am SO blessed that one of my former holistic doula students is one of the nurse policy makers of obstetrics there. She is a homebirthing mama herself, and is mired in an environment that often makes her weep with frustration. She is stopped by her OB colleagues and asked, "you're an intelligent, educated woman! Why would you take such risks by having your baby at home?!" Obviously, they're not reading the literature! Today she told me the most challenging thing about being an OB nurse was that, having done her doula training, she thought she would be able to help a ton of women who wanted natural births. And then she realized that the vast majority of women coming in to birth at the hospital aren't even remotely interested in birthing naturally. She cried a little telling us that. Still, she works on, slowly, carefully, and with delicate diplomacy changing the policies she can. It is change that occurs in miniscule increments, but has profound effects...like a baby no longer needs to have a weight in its chart in order to transfer to postpartum...no separation from Mom's skin until a couple hours later if that's what Mom wants. If a woman needs an IV for whatever reason, like to administer antibiotics, they are no longer tied to the pole. She taught her staff to do saline locks. I so admire this lady, and the courage it takes to be taking on such a huge system that is extremely reluctant to change and think outside the box.

She, my training partner, and I met at the hospital today in order to create a doula training for nurses. Our goal is to help new nurses learn about the value of natural birth, and how to support it if the patient is open. This hospital is at least interested in lowering its intervention rate. The chief of obstetrics has been very interested in our statistics, and is curious to see what we doulas can do to help them. The challenge in our town is the incredible shortage of nursing staff. It is simply not feasible to take several nurses off the floor at any given time to do a workshop with them. They often have to take care of 4 labouring woman at a time! So we are devising ways of screening what patients would be interested in receiving labour support, and being mentors for nurses who wish to shadow us doing our jobs.

This is extremely exciting for me. What I know about nursing training here, is that during school, a student nurse might witness a birth or two, one of them almost always being a C-section. The other is most likely an epiduraled birth, since the epidural rate for first time mothers in Montreal hospitals is around 98%. So then they come to work in labour and delivery, and are suddenly surrounded by ladies in active labour...who tend to vocalize quite a lot in many cases. Without any training or support whatsoever, they have to deal with these whirling dervish like labouring people, trying to keep them on a monitor to keep their own jobs. Plus, if they've never learned about the value of labour sensations, the way they conduct a beautiful symphony of hormones, and all they perceive is abject misery, OF COURSE they're gonna push drugs! They are taught that labour pain is a nasty side effect of the birthing process, not something that a woman can perceive as intense, but manageable and even amazing given the right preparation and support.

So, our job as doula trainers is to help OB nurses learn about birth. Sounds crazy, doesn't it, that the people who deal most with birthing mothers are in fact in the dark about how labour unfolds and why it is intense, rich in sensation, and often for most women extremely painful at times...but do-able. They don't have time to observe the endorphins or the beautiful oxytocin induced high that makes a lot of women very sexy and loving during labour. They don't pay attention to the profound rest in the spaces, where a woman can gather energy for the next wave. Often, an inexperienced OB nurse's method of helping with labour support is to yell, "BREATHE" in the woman's face, trying to control her, giving her the message that the reason she's feeling pain is because she's "out of control" and not breathing right. I've never done a breathing technique in my life and birthed just fine, thank you very much, and would have been very offended by someone forcing some kind of aggressive technique on me. Not that I think there's no value to breathing techniques...if a woman feels this will work for her, it's a tool she should have...many swear by it, so I respect that. But the "BREATHE" from nurses is usually not calm suggestion, it's just a fear response, a desire to DO SOMETHING to SAVE this poor creature from the devastation of a pain that will somehow do something so horrible to her, we cannot even bear to witness it. This is what many nurses believe, and what many convey. And if a nurse conveys this message to a labouring mom, a nurse being a medical person, thus someone who, according to a patient, knows what they're talking about, then she must be right. And so enters the epidural, and truly, you can just hear the sighs of relief from hospital staff when a woman is talked into "her" epidural.

If any OB nurse is out there feeling offended by this, I deeply apologize...I can only speak about what's going on in my neck of the woods, and it in no way applies to everyone. There are lots of nurses I work with who are master labour supporters...very skilled and loving. There are many who are as frustrated as I am at the lack of training nurses receive in school about how to hold the birth experience skilfully. These nurses, however, are so busy with their jobs given a nursing shortage crisis, they are not in a position to be able to teach the newer nurses. They have asked we doulas to help out. I want to shout out from the rooftops my love for OB nurses, and how I respect their work, and how much I know they shoulder in every way. Many have become friends over the years. I just know with a little guidance, a whole new world would open up to them and to the patients they serve.

A 98% epidural rate could most definitely be reduced if a nurse came into the room during a loud contraction, and she stood calmly smiling, whispering, "you're so great...you're doing it, Hon! You're getting there!" It would be so much more effective than being all tense and scared saying, "you know, this is only going to get worse...I think you'll relax more if you take the epidural...after all, you need your energy to push, right?" (insert image here of Lesley banging her head repeatedly against the wall in a rage of frustration) Oh, the disempowerment! I know it's not intentional and malicious...it's just so...counterproductive. This is our culture.

Instead of wallowing in the quagmire of frustration, however, I will get really positive about the fact that I am allowed to go in there and SHAKE IT UP!!!! I get to change some minds. I get to demonstrate how to be comfortable with expressions of labour, how to be gentle with a labouring mom, how to not force her to be intellectual when she should be allowed to be in primal mode, how to respect her space, and how to provide basic comfort measures if she should so desire them. No, I'm not naive enough to believe a nurse can change the mind of someone Hellbent on wanting an epidural, but I do believe she could help those who might be open to discovering what walking down the road of natural birth has to offer.

So an exciting day in Doula Land!

Wednesday, December 16, 2009

An Elegant Soiree

I just enjoyed a lovely meeting with the MotherWit crew and our clients. We got to provide information for couples wondering about doula support. We connected with pregnant clients who wanted to meet our backups, and to meet up with other parents-to-be. A couple of postpartum couples and their babies came too, so the pregnant couples had the opportunity to hear about how great it was for the new parents to have a doula present for their births. The dads seemed to be especially touched by our care. It made me really happy to know they felt nurtured throughout labour as well.

It makes me feel content to see a community being built. Feeling isolated when so many incredible transitions occur throughout the childbearing year is something I want to help new moms and dads avoid. Nobody should fall through the cracks with their need to share and learn unmet.

As an experienced doula, I charge on the higher end of the scale. Some of the less experienced though wonderful doulas who work with me charge less. I want us to remember, though, the women who may not have access to doula care at all. Even though it is widely known doulas help reduce the rate of interventions, thus lessening the burden on our overwhelmed healthcare system, it is a service that is a luxury to most.

We asked tonight, in the spirit of the holiday, for donations to help fund doula care for women without the means to afford it. Think about the women who come from a background of terrible abuse, and need the safety of protection. Think about victims of rape coming from war torn countries. Think about refugees, with nobody they know to help them in a culture that is unfamiliar. Think about incarcerated women, or women who have been widowed or abandonned with no financial means. Compassionate care is crucial for these women as they journey into motherhood, and it should not be a luxury only for those who can afford it. We were blessed to receive generous monetary donations, and gifts of newborn diapers, and will pass them on to Montreal Birth Companions, who provide doula care for these women of need. Every pregnant woman needs support, every baby needs a mother who is treated with respect and given physical and emotional nourishment. Doulas are in the best position to provide this support when there is no family or other resources available. If you've been thinking about helping out someone less fortunate than you this holiday season, make a donation to a volunteer doula service organization in your area.

It truly does take a villiage to raise a child. Building community, finding support, supporting others...this is the best way to get your needs met as a parent, and to provide a strong foundation for your family. A mom with her 7 week old baby asked me if it was okay if she breastfed in front of the group, and of course I told her not only was it okay, it was important! As she happily breastfeeds her child, she sets that tone for others to do to the same. The more people do that, the more healing this brings to our culture of what Ina May Gaskin brilliantly calls Nipplephobia. Your community gives you strength.

So I leave you with some thoughts about reaching out this holiday, asking for or providing some help for your neighbour or a friend. Don't worry if you've lived next to them for years and have not spoken much. Even a simple gesture can be very meaningful. My beautiful midwife for my third child had words of wisdom I have always remembered. She said, "be generous with each other...open your hearts." Words to live by.

Tuesday, December 15, 2009

Sitting with Dying

This blog isn't about the dying we sometimes see in birth, which is certainly painful. I have been present for the still births and deaths of some babies, and this is tragic.

Rather, I would like to reflect upon the experience I had sitting with a friend tonight who is close to leaving this earth. She is not a friend I saw every day, or even someone I've known for a long time, but she is someone I connected very deeply with, and whom I have kept in touch with over the period of a few years.

I found out she was ill about a year and a half ago, and called her to tell her I had heard about it. She was really positive she'd make a full recovery, and was doing great. We continued to talk on occasion, about life and death, always making plans to get together, and always getting caught up in the busy-ness of our own lives. You never really think time is going to run out.

I found out from a mutual friend of ours a couple months ago, that quite suddenly she had taken a turn for the worse, and was potentially looking at facing death. This weekend I met up with another mutual friend I'll call V, and she confirmed that this lady was indeed leaving us, and soon. In fact, V said if I came to visit, it was likely she wouldn't even recognize me, her illness was so advanced. I asked her if she thought it was okay if I came to visit, and she said "of course... she loves you! Just come and hang out." So tonight I went.

When I arrived at V's house first, I was devastated, because she met me at the door in tears. I thought I was too late. But V was just expressing sadness at the impending loss. We took a cab. She warned me our friend was now like a baby, that she hadn't talked for awhile, and needed help getting around for simple things, like getting to the bathroom. But I found myself very very blessed to have arrived on a night when she was lucid, and able to speak. I could hear her familiar voice, coming from the bathroom as she spoke to her mother.

I went downstairs for awhile until she was finished in the bathroom, and then took a breath for courage and went back up to her room. And there was my lovely friend, lying in bed. Her appearance was certainly altered...but still the beautiful face I know and love. She looked hard at me through eyes hazed, and like always, I was struck by how searching her gaze is. She has always dug for authenticity. That is her essence, and illness has not touched that. Tonight I was grateful for my experience with birth, because it has made me comfortable with intense physical and emotional expression. I could mirror back to her what I do with my birthing ladies, which is absolute acceptance for their experience, however they need to do it. I am confident my friend found no fear or pity in my eyes, only love, presence, and acceptance. She was absolutely safe with me to do whatever might happen, whether it be vomit, cry, yell in pain, whatever. Her eyes filled with tears and dripped down her nose. What she wanted to do was remember, relate, tie up our experience together in her mind. It was healing for us both.

My friend feels her emotions deeply. She gets frustrated with how heavy her body feels. She cannot eat. She is in pain. There is no inclination or ability to swallow feelings, to play games for anyone. There just isn't time. People say there is no dignity in dying, or in giving birth, but I don't feel that way. I find there is a serene beauty that comes when someone is living on this edge. Everything has broken down, and everything has become coloured by pain, even isolated by it. When someone in this situation can be held with acceptance and love and know there is no shame in where they are, they are free to just be...to live as presently as possible until there isn't any life anymore, no matter what control their body takes from them.

To feed her liquid from a spoon, to tend to her, was an honour. To have her even remember me at this late stage is a gift whose worth I cannot even express. When she is kissed or has her hand held, she smiles so sweetly, taking it all in. Her loved ones are there constantly, and she is surrounded by support. If she can take anything with her when she goes, it will be the incredible vibration of love that encircles and permeates her.

The atmosphere in the room is one of peace. Like during labour, it has a timeless quality....even though the person in the room dancing with this force is unpredictable and often very intense, the periphery and spaces are serene. When a human being comes in, they do it on waves, and the energy is of growing momentum, crescendo, then birth. When one is dying, it's like the waves of intensity swell in, and the person is drawn back a little farther as each wave recedes, instead of closer, as in birth.


Strangely, I did not feel overwhelmed by a desire to bawl, like I thought I would. I just felt so much joy for the gift of these moments we got to spend together. Who knows what ANY moment brings? I see her family suffering, and am deeply sad for how hard this is on them. This is never easy. We as human beings are so attached. This is our thing. We are attached to our forms and accomplishments, everything that makes up our identity and environment. It is the attachment to these forms that causes us such sorrow when they're lost. For that I am filled with grief for the soon to be loss of my friend and for the loss her family will suffer. But for her, once she sheds these attachments once and for all, she is without suffering, without limitation. She is free. And knowing that, my heart is lighter.

My friend fell asleep before we said goodnight officially. I didn't want to hog her from the many loved ones who wanted to spend time with her too. So, without any defining final moments, I left. I don't know if I'll see her again. I left her family my number, and if there is any reason she asks to see me or anything I can do, I will surely go. But I think we did we did what we needed to do. We wrapped up our friendship in a beautiful collage of memories, and celebrated our dance together on this earth. I cannot express how glad I am for having had that opportunity.

Hug your loved ones tonight. This gift of life right here and right now is a precious thing.

Monday, December 14, 2009

Dealing with Anger

I am so curious to know how other doulas cope with situations in which their clients are being treated very poorly within their chosen place of birth. I have my ways, and so far I am still allowed to work in hospitals, so in some ways I'm doing okay. I am working on trying to make sure those ways don't cost me too much emotionally.

In some parts of North America, doulas are welcomed into hospitals and birthing centres with open arms, and valued as crucial members of the birth support team. In other parts of the world, they are not allowed in. Here in Montreal, I am blessed to work with really great people, most of whom I trust, and who trust me. But this is not true, unfortunately, for doulas in general. I think it's more because I am a very familiar face at most of the hospitals around here, and I work with great caution, meaning I practice delicate diplomacy. In many ways, this has great benefits, because my clients get to birth within an environment of peace most of the time. There is not an undercurrent of ugly conflict and hostility between doc/nurse/and doula. This is extremely important to me, because obviously, this is not the ideal atmosphere within which to give birth. The more I keep things conflict free, the more I am trusted, the better the environment is for my clients, the happier their births, and my welcome in the hospital is continued. But it does mean there are times I have to suck up a lot of nasty stuff that's not so good for me either. I do it for my client's well being, and work hard to process the nastiness so it doesn't stick around inside me.

Alas, I get told a lot by various members of hospital staff, "before the patient came in, they called in and said they were bringing their doula...we were all rolling our eyeballs and getting ready for a fight, but then we saw it was you, and thank goodness, we can relax now, because you're fine...we like you." This sentence does not stoke my ego, believe me. It makes me really sad that there are a lot of doulas out there, trying to establish themselves and their good work, and are being held in prejudice before their feet get off the ground.

Unfortunately, because we are under a lot of scrutiny, it can only take one or two incidents to put staff members off doulas. I am privy to some stories medical staff relate to me about some behaviours that are not going to help our doula cause at all, our cause being to create a safe emotional and physically comfortable environment within which our clients' births will unfold as naturally as possible, if this is what they wish and what is meant to be. A lovely nurse came up to me a few weeks ago and said, "there is a doula who came by yesterday, and every time I came in to look at the monitor or put up the Synto (synthetic oxytocin), she's get in my face and say aggressively, "what do you think YOU'RE doing?" This nurse told me her feelings were hurt, and she hated coming into the room and being criticized for doing her job. Because after all, if she doesn't do her job, whether the doula likes it or not, the nurse will get in trouble. Another nurse told me she walked into the room to see a doula doing a vaginal examination because she thought the resident's exam was incorrect. In our neck of the woods, it is not legal for doulas to do internal examinations. This crosses the line into midwifery. Now, if some doulas out there do do exams, that's their business, but to publicly do it in supposed defiance of a medical person, is not a good doula move. Other staff members tell me, "the doula told the mother to stay home with her waters broken for 48 hours." Whether that's true or not, it is so important for medical people to know that it is not our job to tell women to do this. Our job is to explain what is expected of them by their doctors, honestly outline all the risks the medical staff are concerned about, have the clients do their research if they do not want to follow those protocols, and then let the mother make her own informed choice. It should always be extremely clear that we don't tell our clients what to do.

The way I figure it is this: our clients are choosing to give birth within a medical environment because this is where they feel safest. This is how THEY feel, whether we as doulas agree with them or not. They are hiring us to be a sounding board for information, a person who stays with them the whole time, and someone who will care for their needs for emotional/physical comfort. This means they are, to some extent, willing to accept some of the rules and protocols of their particular hospital in exchange for the security they feel by being there. If they were against everything the hospital stood for, they would find other choices. If they say there are no other choices, it's not true...there are almost always alternatives we can guide them to if they wished. If a client is completely anti hospital and has to go there anyway for some reason, we cannot get into that whole 'fight the hospital" thing with them. We can't make them even more frightened of being there than they already are. We can't come in with them like Don Quixote with the intent of doing whatever we want. It's bigger than we are, and our attitude will make overworked, usually well intentioned staff members stand up on their hind legs in defence of their work, and this will not translate into the most compassionate care possible for our client, which is what we ultimately want, or should want. If we are going in there with the intent of trying to change minds by choosing a more confrontational approach, we have to know nobody is going to suddenly get a look in their eyes like they just got a bucket of cold water over their head and say, "oh, thanks...I've been so wrong all this time. Thanks for opening my eyes." This is NOT me criticizing the benefits of confrontation at times, honestly. It is not to say our beliefs are wrong. It is just me saying that in this situation, where it is known that just by hiring a doula the client is already making a statement that she wants some extra care the hospital is not able to provide, it doesn't take much to make the situation tense and defensive.

So what do you do as a doula when things get ugly, no matter your great intentions and careful behaviour?

Before getting into that, I just want to give credit where it's due. Doctors and nurses are extremely hard working people. We have a terrible shortage of medical staff, and, not getting paid close to what American medical people make, they are working their tails off. I also want to emphasise the amount of responsibility these people have. It is all fine and well for us as doulas to be against many of their choices, but we are not coming from a place of clinical responsibility. Even in Canada, grief stricken parents do blame doctors for bad outcomes, and do sue. These fears, not to mention challenges with insurance companies, add a lot of fuel to the already incredible responsibility these people have. For example, a guy I work with sometimes, a stellar doctor and really good man, sent my clients for an induction. The baby's heart tones had not been so great in the regular prenatal checkup, and the non stress test had shown some concerns, though nothing that sounded out signals of "emergency". I met up with the doctor in the hall and said, "you must be really concerned if you are sending them in for induction." His answer always sticks with me. He said, "I hate having to put them through a procedure they clearly don't want. I'm aware of how much harder it is and some of the risks involved. Do I think I can send them home and most likely everything will be just fine? Yes. Can I as a doctor? No. Because what if, God forbid, they come back, and there IS a huge problem, and I didn't do my job, as aggressive as the choice for induction is, to ensure the safety of the baby when it is true I saw some things in the heart tones that were a concern? What happens to them? what happens to me?" You know intellectually the amount of responsibility a doctor has, but to see it in his eyes, to know it in your heart, is a bigger thing. It actually created a lot more compassion in me for their struggles. Obviously, this doctor's patient chose to induce. She had a painful labour, chose and epidural, and had a beautiful vaginal birth in a supportive environment. Do I dislike induction? Yes. Did I try to change this woman's mind? No. I trust she is smart enough to make her own decisions. I'm just there to support whatever presents itself, not just the things I wish for.

In my experience, most OBs, family docs, and nurses are like the man I mentioned above... concerned for their patients' wellbeing, struggling between what the patients want and what they feel are safe options for a safest outcome. There is a lot of work to be done about certain medical protocols, certainly. Even a lot of doctors agree. So holding them in contempt in our hearts, even if we don't act it out, can hurt the birthing environment. My wise and wonderful doula colleague Rivka has a saying I try to live by: "when you enter the birthing room, come in as clean as a newborn baby." This means don't be judgemental. Don't be on the defensive. Cultivate openness and compassion as much as possible, and if something bad comes up, manage it as non-confrontationally as you can.

So back to that: how do we manage when things are not feeling good in the room? There is a Facebook group out there called "My OB said WHAT?" It is shocking and at the same time entertaining. A lot of wounded women get to get their feelings off their chests and receive support for the emotions surrounding the thoughtless things that are said to them, so I understand the impetus to post those things. I do want to re-iterate, though, that we should see those sayings as being from unaware or unkind individuals, and not look upon obstetrics as something evil. We would feel bad as stellar mothers to have something out there entitled, "My mother said WHAT?" and have bad things we may have said to our kids aired out, even if we are good overall, or the words of bad ones reflected badly upon us as a whole.

So now I will share a few terrible things I have heard and seen, and how I tend to cope.

A client, dilated nearly to fully, all on her own steam, feeling great about herself: an OB goes to give her an exam, and knowing how much she is bothered by cervical examinations, I hold her hand, and prepare her by having her take some slow breaths. The doctor looks at me scornfully and says, "it sounds like you're preparing her for the worst." The client picks up on his tension, and finds the examination very painful. He says to her, "what's with all this huffing and puffing? If you react this way from my fingers, how do you think you're going to get a BABY out of there?" I'm thinking, "did he just SAY that? Did I hear this clearly?! Is this person really that insensitive, or am I on PUNK'D" The room goes silent. He walks out, demanding more fetal monitoring, obviously clearly believing these natural birthing people are being cavalier about their baby's wellbeing. The mother is MAD. The father is irate. What do I want to do? I want to run out of the room, jump on his back, claw with insane fury at his face and ask him if he has ever experienced rough fingers in HIS almost fully dilated, un pain medicated cervix. I want to hate him with all my guts and put curses on him. I want him to break out in painful zits all over his bum. I want nothing good. Would this help? No. Would some pithy, put-him-in-his-place statement clear the tension? No, because he is clearly not into this whole natural birth crap, and already think we are walking criticisms of his work, even though we are not. Well, not 'til then, anyway. So what did we do? When he left, I looked at them, and suggested we all take a really deep breath. We each vented our pain and frustration at his words together just to release the tension. Then I suggested for the time being, we let it go, and make sure we be as friendly as possible to him to make sure he has no excuse to continue his rudeness. The nurse encouraged the mom and dad to think about making a formal complaint later, which they did, but for now to forget about it. I imagined, which I do when I'm really upset, that I'm a dragon, and I breathe all my anger into a fireproof bag that I fold up and place on a shelf until I can open it and do something with it in the future. When the doctor came in and saw the patients had agreed to the monitoring, he seemed to relax and know he wasn't dealing with what he deemed crazy people. When he saw we were actively friendly with him, he relaxed and had a much better attitude. This is not to say anyone excused his behaviour or became his pal, but we refused to let his mistrust and negativity poison the environment anymore. By choosing to treat him with respect in spite of his own lack of respect, we were taking the higher road, creating a clearer energy. Had we remained in a state of victimization or fury, the birthing environment would have gotten increasingly polluted. This wasn't easy for me, believe me. I had to take a little space to hold his image in my mind and force myself to wish for his wellbeing, to send him love as a fellow human being who was going to witness and help with this sacred event. I had to remind us all to love and accept ourselves in the moment instead of buying his words, which were HIS words, based on his fears and shortcomings. In short, we dug for compassion.

One birth several years ago was particularly challenging near the end, not for any physical reasons...the mother was birthing like a champ. Her doctor was not a natural birth advocate at all. He paid lip service to it prenatally, but when it came down to it, he didn't have experience with or believe in the fact a woman could do it naturally. So when he came in to "deliver" my client, he began, without any explanation, to give her a pudendal block. This is some scary old school pain blocker, nothing which my client wanted. She had no idea what this big needle was, and was unaware what was to happen. I leaned over to her and said, "your doctor is about to give you a medication which...." I was interrupted with an explosive yell at me to keep quiet. Unbeknownst to me, before this occured, the doctor had taken the father out of the room to tell him he wanted me and the prenatal yoga teacher who was with us out. The doctor was angry because our client was unmedicated. The father was an incredible advocate for his wife, and said, "these women have helped us have get to full dilation naturally. They are staying, and there's no $#%^$ debating it!" When the doc told me to shut up, I shut up, because there was nothing I could do about this needle going into my client's vagina. When he started guiding her to push, I was by her ear, whispering calming words. Again, he yelled at me to step away from his patient, that I was getting in the way of her being "coached". He got out the scissors to do an episiotomy and forceps. I was absolutely powerless to stop this horror show from unfolding. I was debating stepping between the doctor and my client, or yelling FIRE or something drastic, the anger and helplessness building. I was overwhelmed by the misery of powerlessness and fear for my client's body. Then I looked over at the yoga teacher, and I learned in that moment where my power lay as a support person and space holder. She had her eyes closed, and I could feel strong waves of love emanating from her. I saw with clarity what she was doing, and decided, for the sake of the baby, to quickly follow suit. I took my rage, nausea, and horror, and transformed it into love for that doctor...for the mother who was giving birth, for the father, who was now being held up by our yogini friend because he too was overwhelmed by what he was witnessing. She was whispering into his ear. We all joined our intentions together to create the most peaceful, loving environment we could for the arrival of this sweet, innocent being. We needed to clean up our rage at what we could not in the moment control. We could not linger in the victimization for now. We HAD to transform it, and the only way was to intentionally love. This may sound like a weenie thing to have done, but I swear to you, it worked. The doctor delivered this baby, for no reason known to us, by forceps...thank goodness he was very practised and skilled with this procedure...and the baby was well...a peaceful, beautiful little soul. Strangely enough, though Dad, the yoga teacher, and I were traumatized by what we had witnessed, the mother was not. She seemed to take it better stride than anyone. I am wondering if the collective web of energy we wove around her and the baby helped the trauma not anchor itself into her experience. I don't know. But I do know that from that time on, I chose to deal with these situations of powerlessness with active non-violence.

I saw a mother do the same thing spontaneously once. Again, it was a natural birth, and the doctor came in and said, "I'm going to cut you, otherwise you're going to explode." Now, what a lovely image for a birthing mother to have in her mind as her baby crowns. The medical student, who was gently sitting there, allowing for a nice long crowning, said, "I think she's stretching really nicely, actually." The doctor became irate, snapped off her glove, crossed her arms, and said, "well, then why am I even here at all? If you all know everything, you can just deliver your own baby!" Crickets chirping in the room. Then the dad lost it. He started screaming, "How DARE you talk to my wife like that when we are giving birth, what is WRONG with you?!" The mother, dreamy eyed with endorphins, said, "Honey, it's just her stuff. Let's just focus on having our baby peacefully." The doctor shut up, the father calmed down, and the med student had the most beautiful smile when she caught the baby and discovered absolutely no tears to the mother's perineum...not one teeny, tiny little "explosion".

I have a lot more stories like this, sadly. But the point is that they ended well. In choosing to be calm and loving, instead of angry and confrontational, which would surely have felt good in the moment, I feel we helped create a better environment for the baby and reduced stress for the mom. Yes, by birthing in hospital we risk these situations. But luckily, they are rare. Most of the care my clients receive is respectful and compassionate, and I am truly grateful for some of the life saving interventions I have seen in my years of practice. A doula cannot control everything that is done, but we can help to mitigate some of the emotional risks.

So what do I do with those fireproof bags in the end? I go into a safe space, open them up, and let the emotions come out. I release them, and envision them transforming into a greater capacity to love, a better ability to hold difficult situations with peace. And then I write about it.

I leave you with a song I absolutely love by K'Naan, who was born and raised in Somalia, one of the most violent places on earth to live at the time. He speaks of his mother, who even though she was beaten and threatened with her children being taken from her, she gave those who harmed her prayers. K'Naan thanks Africa for his hardships for making him capable of giving. He talks of creating his own medicine by processing the worst situations he's lived through. I am moved by that humbleness, and think there is wisdom in choosing peace where we can.

http://www.youtube.com/watch?v=DIhm94a-8SE



Friday, December 11, 2009

The Goings on at MotherWit

At the MotherWit HQ (which is on the corner of my couch on my wee Net Book where I can hang out with my family and snuggle various children and a German Shorthair Pointer dog named Lola on my lap), we are being very productive. I am in communication with my doula A-team as we prepare for our next "Meet the Doula" Soiree. My genius MotherWit Postpartum Doula Millie and I are structuring her postpartum doula care packages and creating a PHENOMENAL post-partum doula training for 2010.

The MotherWit website is being formed a little at a time. I work almost every day, fully booked with pre/post natal appointments, and then come home to be here for the kids, make dinner, etc. So of course, things go slowly when a working mother undertakes the expansion of her business. Thank goodness for the constant help in organization and technical stuff from my husband, not to mention the moral support.

I am also working on the MotherWit Intensive Doula Training, scheduled to take place in July. This is really a pet project of mine, as I love teaching, and good doula training seems to be very lacking. I am super excited at the interest that's been expressed about this training, and I want to make it spectacular.

One of the challenges with popular doula training, is how little it offers in terms of coping with the harder aspects of being a doula. Doulas with a lot of experience call it "Doula Kindergarten", yet women are feeling like they're actually prepared to deal with the intensity of hospital situations when they come out of these weekend workshops.

I think a doula's main job is to help keep a woman in "primal brain" mode while she's in labour, meaning she should protect a woman and her partner's space to allow their labour to unfold with as little interruption as possible. Many new doulas like to exist in "do" mode, meaning they do things like time contractions, and oh, the constant suggesting of positions! My wonderful Polarity Therapy teacher John Beaulieu has a great saying..."sometimes, the more you do, the more you doo doo." And it makes so much sense. Being over-solicitous, meaning always checking in to see how a woman is or what she needs, using tools that might not be necessary, doing all these weird walking and jumping around tricks when perhaps all the woman needs to do is sleep, and THE WORST is arguing in a hostile way with hospital staff members, serves to make labour longer and harder.

This is not the fault of the lovely, well intentioned women who go into doula training. It is simply that trying to fit so much into a couple of days of training is just not going to teach students more than the very basics, and not necessarily the finesse with which to use the tools with discrimination. The students are asked to follow childbirth preparation classes, many of them very mainstream, in order to gather education about the birth process. But these classes themselves are usually not taught by people who have tons of experience sitting and observing labour in a non clinical way. These students generally do not have the option of apprenticing with an experienced doula, which is such a valuable way of learning...going to a birth without having to do anything but observe and do a few errands for the primary doula.

I have to say,the doula training I give is pretty good. I say this not with Ego, but because I myself did a doula training oh so long ago and wished I could have had so much more input and supervision than I received. I know where the holes in my learning were, so I try to fill those gaps in the training I give. There was really nobody to talk to when the first birth I went to, I actually caught the baby accidentally at home, because there was not enough emphasis in my training about HOW FAST a second baby can come after the signs of active labour present themselves. There was nobody to talk to when at the seventh birth I attended, the baby was stillborn. I have learned everything through experience, through trial and error, and I will always continue learning.

A doula trainer should help doula her students through the process of learning such a challenging art and science. She needs to be a shoulder to cry on...a new doula is tender and gets upset really easily when she sees how big the hospital system is, and how her fierce belief in natural, un-intervened with birth is not necessarily going to play out no matter what she does, and that her job is to work with WHAT IS NOW, not with what she wishes would be. A new doula needs to talk through the first time a nurse or doctor makes her feel ashamed for being a non medical person, and for being a young, inexperienced one at that. It can be ROUGH without support and guidance. I try to encourage new doulas to work in partnership, whereas I spent years working alone, feeling very isolated. I learn SO much more in partnership. And I never mind when a student of mine, even an allumni of a few years, calls me up to ask me questions or for help to talk her off a ledge of the despair that can come with feeling powerless at births sometimes. I try to do everything I can to prepare my students and give them guidance when they start off.

MotherWit is woman-ed with some wonderful former students of mine. I have worked with all of them at births, and I have a lot of faith in their abilities. They are committed to building a community for our birthing ladies in Montreal, and a community for we doulas, who's need to talk through situations we've encountered is intense. When you are in a profession that has you working with primal, unpredictable energy and have to do this support within an environment that is full of fear for it, you often need to do some serious debriefing for your emotional health. I have no idea how I did it before hooking up with other experienced doulas.
'
MotherWit is also helping to raise funds for Montreal Birth Companions, which is an organization run by my beloved Sister Doula Rivka. MBC provides free doula care to women of need, often refugees from other countries who have no support whatsoever. The more challenging a situation, the more support a birthing woman and new mother needs, so, as MotherWit clients are able to pay for our services, we ask for donations to help fund Montreal Birth Companions. The students Rivka and I train do a lot of volunteer work with this organization, which is both so helpful to the moms who need this service, and a great learning experience for new doulas.

We are also going to be working on a great series of doula-taught prenatal classes. We will NOT give out little charts with smiley faces demonstrating how one feels when ones' contractions are coming at such and such a time apart and the cervix is dilated to such and such a number of centimetres. Truly, that concept is SO ingrained in people's thinking, they can't see the forest for the trees. If we could eliminate the whole timing contraction thing, I think we could lower the epidural rate by a whole ton. I have had women have their babies waiting for contractions to get to 2 minutes apart, had women never have contractions closer together than 7 minutes or so, have had people have 2 minutes apart from the get go, but labour still took over 24 hours of increasing intensity. There are far more telling things to look at to figure out how close the baby is.

So, folks, that's where we're at. I will let you know when the site is up and running. I hope you have a fantastic weekend, that you are warm and safe, and that you have everything you really need.

Thursday, December 10, 2009

Celebrations

It is a cold and blustery night here in Montreal...the wind is howling and the windows shaking. But my night was cozy, safe, and warm. My younger kids, my husband, and I got to celebrate the 1st anniversary of the birth of my buddy Iggy. He is a child who draws a lot of love to him. It warms my heart to no end to see him thriving in every way. I feel blessed to be part of his life. Birth can be such a fiercely bonding experience, and Iggy's parents and I are connected for life after a 4 day labour and a vaginal birth after 2 previous C-sections.

What can a woman endure, let me count the ways! I don't think I've ever met someone in my entire career who worked so hard to birth a baby...not just throughout labour, but prenatally as well. Natalie dedicated herself, body,mind, and spirit, to creating space, to healing, to accepting whatever Birth was going to give her. As feared situations arose, instead of shutting down in resistance, she dug as deeply as she could to learn what was to be learned, and used those lessons to heal. She owned her birth so powerfully by the end, that when a young doctor, who had no idea how much she had truly gone through already, came in and said, "well, we might have to Section you because you've been such and such amount of centimetres for such and such a time," she laughed from deep in her belly. Not in mockery, but in mastery. Her birth shed light upon some of her biggest demons and she conquered them, very likely permanently. She knew there was nothing that was going to come up that she couldn't deal with. And not only did she own it, she loved it. In our culture of high drama which thinks a 24 hour labour is something to emote complainingly about, Natalie looks joyfully upon her birth experience with love and gratitude. To be grateful for 4 days of gruelling labour (we're not just talking about the kind of contractions that you can distract yourself from) because of the things it taught you and how it healed you is probably one of the most beautiful examples of living in grace I have ever seen. No WONDER Iggy is such a special kid.

It's important to celebrate fathers as well. As we looked over the photos from Iggy's birth tonight, his mother was obviously a Goddess, moving that baby down with everything she had. But I need to give his dad Adam serious props, because he had to get his head around all the crazy belly magic and the secret witchy workings of we women in the birthing room. This kind of intense work, the kind only those who work a lot with Birth energy really understand, can make a man feel pretty isolated sometimes. Those photos,however, revealed a man incredibly loving, pouring all his energy into his partner, into his baby, protecting them with all his intention. As scared as he may have been at times with such an arduous journey, and despite how many difficult decisions he had to think about, unsure of what and whom to trust, he allowed himself to be vulnerable, and chose to allow the womens' work to unfold. I have profound respect for how he held that space, even when he felt broken and perhaps nothing like the strong, intense man he is. He had to endure some seriously challenging emotional and spiritual labour pains in order to birth himself as Father, as that is what Birth demanded of him too. And he did it spectacularly. Where and how I ever received such a privilege, I'll never know...but I got to witness it. And hold it. And tonight, I celebrate it. Chin chin, my friend.

HAPPY BIRTHDAY, IGGY! I love you.

Wednesday, December 9, 2009

December Meet the Motherwit Doulas Soiree

Hello New Parents and Parents-to-Be!

You are cordially invited to a gathering hosted by the MotherWit Doulas! Whether you are just trying to figure out whether or not doula care is right for you, want to show off your new babies, or reconnect with friends you made at our last Doula Soiree, you are most welcome!

Come to find out what it means to have a doula at your birth, share and hear birth stories, and have a cup of tea! Come to connect with your community, and find out what resources are available to you.

We look forward to seeing you on:

Wednesday, December 16th, 2009
The Green Centre
1090 Avenue Greene, Westmount
from 8 to 9:30pm

MotherWit, in the spirit of the holidays, would like us all to remember those less fortunate than we are. Montreal Birth Companions (www.montrealbirthcompanions.homestead.com) is an organization which provides volunteer doula services to women of need. These mothers to be are often refugees, with no family to support them. Montreal Birth Companions also provides training to women of many of Montreal's diverse ethnic communities. Any way you can help this very important service continue would be most welcome. If you would like to make a monetary donation, we can provide receipts. Packs of diapers, new baby clothes items (warm things for this season), receiving blankets, etc. are also all welcome. We just ask that formula not be donated, as we believe breastfeeding promotes optimal health.

If you cannot make it to this meeting, know we will be back in January

Tuesday, December 8, 2009

Tired Doula Day

It has not been a good day... not full of birth magic and awe. It is the type of day where being a doula weighs quite heavily on me and my family. I made an appointment, went over, only to find the mother was sleeping and had forgotten, and there was no way I was going to wake her up. I will need to reschedule, but man, I have already spent around 60 hours on this case! I could have stayed home instead. This non meeting cost me a few precious hours of my life.

My little girl claimed she believed I like my clients better than I like her. My 4 year old is acting out, clearly because he is wanting more mommy attention than he's been getting. My husband is a great man, but even he gets tired sometimes holding down the fort. I miss my friends, I miss exercising, I miss my sister, who is visting from England and I barely have time for.

It is not always hearts and flowers every day. But the antidote to the blues is to find some gratitude, so I'll dig for some. I am grateful my last client due before Christmas gave birth a little early so I am not technically on call, except for a mother expecting twins, who will probably go early. I am remembering one of the most important births I have ever attended, important to a profound healing of the web of women's faith surrounding birth, which has been eroded over years by fear. A year ago, my dear friend was in the throes of labour with her third child, working towards a VBAC after 2 previous C-sections. It was a hero's journey in a way I can't even begin to describe. My little buddy Iggy was not born until December 10th, but out he came the vagina way, and taught me a lot about how the healing that occurs in birth can extend beyond just the woman who birthed and the people who were there. Some births CHANGE things, as this birth has on suble levels. So gratitude to Iggy and his beautiful parents, midwives, doctors, nurses, and aunties.

I am grateful for a warm home, good food, and a pretty Christmas tree. I am grateful for good friends who love me in spite of my terrible lack of being able to hang with them much. I am grateful to not have to sleep by my phone tonight.

Love to all,
Lesley

A Word About People in the Birthing Room

I hope you all had a wonderful weekend. I'm wondering if any of you doulas or midwives have experience this phenomenon...the-labour-lasting-forever-even-sometimes-ending-in-section-because-woman-has-no-privacy phenomenon.

Ina May hits the nail on the head when she talks about sphincter laws...how can one progress when one is feeling imposed upon by others, even just energetically? If you're trying to go to the bathroom or make love, and there are people outside...not even in the room watching you, but outside knowing what you're up to, you kinda lose your mojo, know what I mean? Our sphincters are sensitive to scrutiny (say that 5 times fast), and the cervical "sphincter" is no different.

I meet all kinds of wonderful and fascinating people who come to births to help out their daughters/sisters/friends who are labouring. When these people are beloved by the mother to be, AND are truly wanted in the room for their support, AND are sensitive to the needs of the woman and her partner by being quiet when necessary and hands on when requested, things most often go GREAT! We all have a nice time, the birth goes well, the baby is born into a web of even more love.

Now sometimes I meet wonderful and fascinating people who are not actually wanted in the room for most of the labour. They are usually lovely, well meaning people who want to support the woman from afar by waiting in the waiting room, to pop in now and again to say "hi", and to come in after the baby is born. This rarely goes well. It may be the expecting parents don't realize that good labour is not really about chatting and hanging out excitedly and so have the idea it's a social event. And the people, as truly lovely as most of them are, probably don't understand that by lending their occasional popping in support, they distract the mother from her important work when they ask, "how are you? what can I do?" Mothers- to- be are sensitive individuals. They worry about their perhaps bored siblings out in the waiting room, or maybe about their elderly father, who, like a trooper, is camped out all night in an uncomfortable hospital chair, eating yucky hospital food. I can give proof from my little books of labour notes, that this situation makes labour llloooonnnngggg. Or, at least. longer than necessary. When I look at my ladies who take epidurals, many of them do so when there are people in the waiting room. I usually suggest people tell their families to come several hours after the birth, but there is the sense that it is something that is so exciting, that it should be shared from moment one. I understand this, I truly do. A baby is a blessing, and to hear the first cry a gift. But not if it is at the expense of the process of getting the baby out.

Now how about a waiting room with not so nice people, or mostly really nice people but one or two not so nice people thrown in the mix? Or, perhaps they are really nice people, but they are not actually people the mother or father want at the hospital. I see this from time to time, unfortunately. I have seen every politically charged family situation you can imagine. There are the lovely people who the mother-to-be is humouring by inviting, because she doesn't feel like it would be right to have Auntie Pam be in the waiting room over Auntie Meg, so Auntie Pam is just kind of there as a courtesy. Then there is the mother-in-law situation, which is when the paternal grandmother is kind of invited because she's the grandmother too, but whom the expecting mom isn't really thrilled to have around.

Then we switch from the lovely people to the overbearing ones, whom the mother invites because to not do so, would be to invoke World War Three. I have even had a few situations where the people are explicitly told not to come, that they will be called when the baby is born, and to stay at home, and then just show up anyway because they don't know what else to do with themselves and are too excited. The worst, is when the person who sweeps in has some serious ego issues, and pulls dramas and sulks that they weren't invited, and comes into the room anyway even when they are told to stay out. Sometimes, some people just expect to be involved, whether the expecting parents want that or not. This is not help and support, obviously, it is ego serving and an expectation to be included in a private event as if it is their right.

I try to keep the peace as much as possible. If the mom is relaxed and really happy to see the unexpected person and labour doesn't get hung up, fine. If contractions stop, which they usually do, or at least slow down, I try to negotiate space for her. I have to be the bad guy sometimes, going out into a hallway full of wellwishers to say, " the couple is SO happy you love them so much and are so supportive, but they'd really be happier if they knew you were comfortable in your own beds." Most of the time, the people go, leaving some nice food for the parents or with lots of encouraging words, and that's the end of it. But there have been times I have witnessed the grossest acts of disrespect you can imagine, like my asking them to please leave, and being met with absolute hostility towards myself and the labouring parents for having the audacity to not relish their presence. I remember one beautiful labouring mom, having a hard, long, painful labour with a hallway full of very demanding in laws. The sweet father was busy supporting the mum, and was having a hard time standing up to them all. The mom finally said, "I FEEL them out there, and I know it's hurting my progress." A doctor finally had to shoo them away with threats of security, and I kid you not, that lady dilated to fully not 15 minutes after the last straggler left.

But some don't leave. I am sad to say this, but in situations where there is not ease with the relations who are waiting "out there" somewhere, and especially with the ones who flounce into the room uninvited because they think they're so important it is their right to participate, the C-section rate is high. I have even heard a couple of doctors mirror this observation. The epidural rate is over 50% in this situation, and C-section potential doubles for first time moms. Just from having extra vibes around, the labour can change...when the vibes are well meaning it is still usually a harder labour with request for pain relief, but when they're not nice, it is positively detrimental. When I get to the hospital and know this birth is going to "waited for", I call my husband and tell him I won't see him 'til tomorrow at the earliest.

It's challenging for doulas too, because we bust our asses doing our job. So to emerge from the birthing room to have a pee or a quiet moment in which to think about our next move, and to be met with faces ranging from the sweet to the hostile, asking for/demanding information and updates, there is no breathing space. Sometimes I want to whine and complain and vent to a fellow doula on the phone about frustrations or get some fresh ideas, but I can't because there's someone wanting to chat. It's not that I don't like chatting, truly I do. But maybe not at 3 am when I've been there since 3am yesterday, and I'm suspecting the reason the labour is taking so long is because of the one engaging me in the chat.

I try to educate my clients on the importance of not having stragglers about, only true chosen support people. But if they don't agree or get a look of horror on their faces when I suggest this, there's nothing I can do but my job. I stay centred and try not to put my projections into it, because, after all, what do I truly know? But I'm hoping there are some moms- to- be reading this and are re-thinking their support strategies, or perhaps some people who are really attached to being in a waiting room who are changing their minds, or maybe a doula or two who are also making connections between long, medicated births and Peanut Galleries.

After all, those people weren't around when the baby was being made, right? Neither was I, but I know how to skillfully flow with that sexual energy of labour, and am an honoured guest into that inner sanctum. My presence, for the most part, will not hinder labour, and if it did, I'd get out of Dodge fast. If I see Mom's labour stalling, I usually go for a coffee and come back to see a little intimacy with her partner has made the labour escalate, and she gives birth not long after.

I would love to hear if anyone has similar experiences!

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.

Wednesday, December 2, 2009

Moon Musings

Tonight is officially the full moon. I took my girl dog Lola and my younger daughter down to the lake this evening to bask in Grandmother Moon's rays. It is a lovely moon tonight...powerful, but softly benevolent, wrapped in some gauzy clouds.

Today has bestowed some special blessings. A couple I am working with has discovered that the twins the birthing mother is carrying are NOT afflicted with a chromosomal problem it was thought might cause severe problems. This is SUCH a relief for this couple. It has been so hard to embrace their pregnancy with joy, as much as they have worked on staying present, grateful for this pregnancy. I am so happy for them. They are an unbelievably warm, loving couple whom I know are going to be exceptional mothers. Their home is woven with their honour and respect for each other...a beautiful environment in which to nurture a child.

I was also blessed today with the healing of a challenge in a relationship that is very important to me. There is such a wave of peace that surges in when the conflict and the feelings surrounding it are released, and the road is paved for an even stronger relationship. I feel like a ton of weight has been lifted off my shoulders.

I like to take the time of the Full Moon to count my blessings. I also think it is okay to be a little more personal in this blog at this time. I am grateful for my family...my sons and daughters, and my husband, as well as my mother, sisters, father, stepfather, and grandmother..the list goes on, you get the drift. I am grateful for dear friends, for my health, home, and abundance. I am grateful to be living my calling, and that I am humble enough to know there is always so much more room to learn and grow. I am grateful for the gifts that help me do my job to the best of my ability. I am grateful for the motivation to remember to be thankful to Grandmothers on the other side, whom I know give me guidance when I need.

I am grateful for you, too. Tonight, maybe light a candle and say some words of gratitude for what you have, no matter how hard things may be for you. As you blow out the candle, imagine those heartfelt thoughts going up up up to the moon, honouring Her for the pull she has on your own inner tides, whether you are aware of them or not.

Blessings to all.

Community Birthing in Jamaica

Interesting article from Midwifery Today about community birthing in a Jamaican hospital.
http://www.midwiferytoday.com/articles/community.asp

Tuesday, December 1, 2009

Such a sad, sad story.

http://www.google.com/hostednews/ap/article/ALeqM5hP50wdNKi7d3tlLl_KBQWS1ube0wD9CAQRRO0

Monday, November 30, 2009

In Praise of Spaces

Birth is so much about swelling, surging, growing, stretching to maximum capacity, riding the waves, and being full to bursting.

I want to take a minute to remember the importance of the spaces. The pauses. The rests. We spend so much time as doulas and birthing mothers supporting/coping with dizzying heights of contractions. And this is important, because these waves require a lot of our attention and a commitment to working through their challenge. These waves create gifts. The endorphins which make us stoned and the oxytocin which makes us loving and sexy in good labour, are the gifts we can bring to the spaces. These gifts allow us to sink into the ocean of Resource available to us, if we so choose.

But many of us do not choose. We are products of big, over-thinky minds. Our minds are like impatient children, demanding "why". "Why is labour taking so long?" "Why does it hurt so much?" "Why isn't it ending soon?" "Why is this happening to me?" I have seen so many labours deteriorate with our cultural obsession with the question "why". The truth is that there often are no real answers. There are thoughts, and hypotheses, but not always something concrete, which insults our minds, which feel entitled to answers for their demands. We then take awareness away from our bodies, which would benefit far more by resting between the great big swells of active labour. By wallowing in the "why", we deny ourselves the potent Medicine which exists in the spaces.

Unfortunately, many supporters of birth are far too willing to engage in theories
in order to help the woman to "understand" her situation. This often does not help. Information itself is not usually what heals. Many "bring to hospital" lists include magazines and movies in order to fill the space. Medical students are asked to do questionnaires and workups in the spaces. Nurses chat between contractions to get to know their patients. It is hard to find the space in this environment, the space to regroup and re-source. We need to work on this, as natural birth should not have to be next to impossible in a hospital.

We can help to create more space through many means, depending upon what's going on. Breath is an important way to make room inside. As we breathe deep into our bellies, into the space around and below our settling babies, we make room for everything to open, allowing our babies to settle more deeply. If we make the conscious choice to put down our minds, sink down into the spaces of our wombs with our breath and our quiet, aided to do so more deeply with the gifts of endorphins and oxytocin created by the waves of contractions, we find where our Medicine lives. Our most womanly power exists in these spaces, the power to nourish and restore before bringing forth life on a wave. Our Medicine is Grace. It is Courage. It is Faith. It is Love. It is Endurance. It is Acceptance.

Space can be created by assuming positions which encourage our babies to follow the path of least resistance. Vomiting, peeing, and shitting during labour are valueable too, because they create space. They relieve tension. The image I get when I think of vocalizing during labour (ie: yelling our heads off), is of making our personal containers bigger with the sheer force of sound in order to hold the crazy, overwhelming birth energy. Space is created by processing the emotions that come up in labour. A good cry can create renewal. Letting go of what we hoped for and accepting what is present in our labours creates the space to flow with what is here and now.

Sometimes space needs to be created in more hardcore ways. And let's make sure to honour those too, as they can provide immense value. Manually stretching a cervix when appropriate can make more space for the baby to be born. Occasionally an epidural is the way to create the space to find our internal Medicine. For whatever reason, sometimes the mother needs to get perspective from the experience and the only way to do so is by putting the pain on "pause" in order for the body to do it's thing within the space of rest.

If supporting a woman in active labour, do not engage her with chatter. Don't probe her for information. Don't fill her spaces. You are denying her access to her resources. When she questions "why", unless there is a real answer, don't go there. Encourage her instead to figure out how to deal with what is, which is usually to pause and go inside. Add to her endorphins and oxytocin by making her feel really good, if that's what's called for, by massaging her or soothing her with whatever comfort helps her. If you're birthing soon, practice relaxation. Know how to let your body go instead of shlepping around the tension of the last contraction with you to the next one, compounding the stress and reducing efficiency.

How do you help to create space?

Sunday, November 29, 2009

control

I think it is so important to know how little control we have over the birth process, as birthing women and as doulas. It hurts a little every time to have this lesson driven home. I think there is a secret belief that if we do everything right, like provide the correct support, use the correct remedies, say the magic words, we will be granted with our clients' births going wonderfully. We go around wondering "why?" when an outcome is not as we'd wanted, and fall into the pattern of wondering if there was anything else we could have done. And while we may come up with hypotheses, ultimately, we don't know much of the time. Who knows what lessons any particular woman needs to come away with, what the baby needed, etc? The "why" is the great mystery, and hanging around there too long is not conducive to healing. Figuring out what to do right now and extricating the important lessons are far more important than believing you actually had that much control anyway.

Being a doula means being able with presence, love, and peace, knowing you pulled out all the stops you could to help the birth run as smoothly as you knew how, look your lady in the eye as she is about to be wheeled off to the surgery she never wanted, and say "Well, here we are." You must be a vessel of compassion for what is present right now, instead of caught up in despair over what wasn't "achieved". We want our moms to be at peace when their babies are being born, as these babies need to be received in an environment of love, not rage or terror, no matter what is going on.

I am just back from a birth in which I supported a woman for 48 full hours, she and I keeping absolute faith in her profoundly amazing body, giving everything we could, doing everything "right". And she ended up having a C-section. Of course I think, "what could I have done?", "was there any other thing she could have done?", "was it the hospital's fault?" And the truth is, I don't know, and never will. What I need to focus on is a mother who will need to heal emotionally from having her baby surgically. I will do so by not denying her full right to grieve, and protect her from those who tell her she has nothing to be upset about because she has a healthy baby and the process wasn't important.

As far as I am concerned, this woman made one of the most heroic attempts at natural birth I have ever witnessed, and the staff at the normally extremely intervention happy hospital we were at were nothing but full of praise, support, and encouragement for her process. The nursing station was buzzing with excitement, even while she was still 8 to 9cm for over 24 hours...with no pain relief at all. There were no snide comments that she was crazy or egotistical for doing this. Just well wishes. The chief of obstetrics came in on a wave of love and support, saying how much he admired her, and since her baby was doing well, he would support her wishes. He would occasionally come into the room, like a doula, to buffer any statements made by well meaning residents or students that were less than helpful. The environment was as nourishing as possible. In the OR, the energy was positively tender..everyone from the anaesthetist to the nurses were telling her how heroic she was and that they applauded her. And they were not just words, the hearts behind the words were palpable. It was amazing how much heartfelt support this woman drew to her. This will lend well to her healing. But even so, healing will need to be done.

It is a huge shock to live in a body you have trusted all your life, and you have done all you could to prepare it for the natural birth you expect, have gathered up a support team to keep the environment safe, and in spite of all that still don't birth vaginally! Ouch! As a doula, I don't even have the comfort of being able to grumble about how the hospital environment discouraged free flowing labour, because they DID, possibly more than any time I've ever seen. I can't use their routines and fears as a scapegoat, because they suspended all of that to allow her to birth freely. And in a way, that leaves me wondering how many times I have conveniently blamed some of the Csections I've attended on the hospital environment. Okay, probably the environment DOES account for an awful lot of Cesareans. I would say most, even. I am convinced that the risks involved in the routines and interventions applied based upon fears of potential horrors are higher than the risk of leaving things alone as much as possible. Yes, there should be vigilance, and yes, there should be skills and technology available. But the "in your face" aspect of the hospital brand of vigilance is so often birth mojo killing. In any case, I admit there very well may be the occasional time I try to blame the environment, in an attempt to grasp at straws for reasons "why", when truly, I can't really always know that. Who am I to judge anything? When we have no blame, we are left with a terrible sense of how Birth really and truly is the great mystery we've always secretly hoped we could have control over by our right actions. How easily we crazy humans get caught up in magical thinking! Yes, we have influence, it's true. There are times I know a woman would have ended up with a Cesarean without my help. So we can as birth supporters do some magic. But the belief in magic becomes insanity when we think we actually created rather than facilitated an outcome that was already probably meant to be, if you believe in that kind of thing, which sometimes I think I do.

There is a saying...Trust Birth! Well, I do trust that the vast majority of time birth unfolds normally and women have healthy babies if we leave women space to do it. If it didn't, I couldn't do this job with the faith I have. But that's more trusting women and their bodies to function normally given the support they need (or by leaving them alone if they don't need it). By reducing fear, I can help the function flow more normally, but only if that was what was meant to be given the sort of harmonic convergence a particular body/baby/energy/alchemy and circumstance any given birthing event creates. The body does know well how to overcome many less than ideal situations, and sometimes my support can get a rough journey on track. Not always, though, no matter what I or the primary caregivers do.

So back to the Trust Birth statement; do I "trust" an ancient, unfettered energy that has the power to give as much as it has the power to destroy without that much notice, and think my puny little hopes and intuitive magical musings actually bring about an outcome She has other ideas about? That would be imprudent. Just because we feel all safe and warm and faithful about birth doesn't mean that makes birth all okay. Yes, I do trust it goes fine the VAST majority of time. But not always, and when it doesn't can be so painfully unpredictable. Put it this way: I don't "trust" Birth enough that I believe every healthy woman should go and birth unassisted. But I do trust that Birth is usually a lot safer than the medical system makes it out to be most of the time. A good balance between a decent supportive safety net and freedom for women to do what they want and need in birth without being disturbed seems to be where safety is at its highest. Sadly, in our birthing culture, this balance is so out of whack, I don't know how or when the pendulum is going to shift to a place of sanity. However, I digress. This birth I'm speaking of may not be a product of this imbalance I so often think is the cause of many less than ideal outcomes. It just is what it is. I was so grateful for Hospital Medicine and what it was able to provide for a safe outcome. This Medicine truly is a gift and I am glad it's so readily available when we need it. I am also over the moon grateful for the tender hearted people who were so skilled and so compassionate in the way they applied their Medicine. A bow of honour towards them.

In spite of the compassionate and skilled treatment my lady received, in spite of some of the given suggestions of why this birth ended the way it did, it is EXTREMELY hard not to have an answer to why things simply go crappily sometimes. What gets on my nerves is everyone sitting around in the recaps of challenging births spouting, "Oh, I KNEW that was going to happen!", or "I THOUGHT that red flag I sensed would amount to something like this!" That's just so easy to say, and unless you're quite psychic, it's all just speculation without some pretty decent evidence (and I DO feel anecdotal evidence and evidence that is beyond the clinical is totally valid a lot of the time...evidence doesn't all boil down to RCTs and clinical suspicion either, otherwise I'd be rich, for example, if I got a dollar for every time I heard a birth ended in Cesarean because the baby was just too big for the mom.). It IS important to recap and to rehash and to delve into the story to learn, but it's also important to hold our hypotheses lightly.

So here I sit in this place of not knowing, trying not to be angry with it, but also being grateful for mystery and for teachings and for stretching my capacity to accept rather than blame. I'm going to choose to allow my heart to be open more to the pain of the fact I don't know anything rather than stick around in the 'why' game, which is the distracted musing of a wounded ego.

Thursday, November 26, 2009

MotherWit on Twitter @motherwitdoula

Follow MotherWit on Twitter @motherwitdoula

Wednesday, November 25, 2009

Royally Miffed

I am one annoyed doula tonight. H1N1 continues to plague our practices. Yves Bolduc, Quebec's Health Minister, said that he felt making a birthing woman choose between her husband or her doula in Montreal hospitals was, in short, paranoid. So despite the fact that I subjected myself to a vaccination I am not particularly comfortable with in order to be as responsible as I can be to my more vulnerable clients, St. Luc hospital is STILL clinging to this rule. My poor clients are distraught. They were told that St. Luc's is a higher risk hospital for the flu, though I'm not sure if I understand why, given St. Justine, which DOES allow doulas and husbands in the birthing room, is a hospital strong in pediatrics. The benefits of labour support outweigh the risk of becoming extremely ill from the flu, especially considering my clients and I are vaccinated. Why vaccinate at all if this is not even considered?

To continue on my rant, I just have to mention that an OB/GYN who attended my lovely client's birth, WALKED OUT OF THE ROOM when she refused to get on her back, despite 4 people trying to physically force her into this position. He threatened her with abandonnment of care. Personally, I didn't see the big deal about his not being there, as the baby was practically out anyway and there was a resident and a veritable herd of experienced nurses in the room. What made me sad was how scared the nurses seemed, as if they were going to get blamed for failing to control their patient. The birthing lady decided to go on her side, and I suppose someone went out to kiss the doctor's butt so he'd come back in and catch the baby.

I have no problem with an accoucheur feeling uncomfortable and inexperienced with a particular birthing position. Most of the docs I know would be respectful and explain why they weren't comfortable and comprimise with a position both doc and lady were okay with. But to stomp out of the room shrouded in a cloud of self righteous indignance to sulk in the hallway is extremely lame. Midwives are down with all kinds of positions, as are some OBs and many family docs, and know how to protect the perineum in just about all of them. Perhaps some skills sharing for the resistant is in order so that women's choices are better supported.

Tuesday, November 24, 2009

Montreal Doula Training Intensive Retreat 2010

When: July 18th to 23rd, 2010 Where: Montreal (Morin Heights) Who: This training is for women who want to pursue a career in supporting women in birth. This can either serve as a complete professional for a career as a doula or as a stepping stone to a career in midwifery, nursing or medicine or as a continuing education for women already working with birthing women and want to enrich their practices. Lodging is available on-site. Please contact us at info@motherwit.ca or visit us at www.motherwit.ca

Monday, November 23, 2009

musings from a very tired doula

Oh, so tired! What a busy week ahead...days packed with pre and post natals, and goodness knows when babies will come and all will have to be rescheduled. But this is the gift of doula work...I never know what the day will bring. Life is never boring.

I am full of gratitude this evening. I live in a world of women, but tonight I am grateful for the boys...a huge thank you to my web guys who make such far reaching communication possible. In my Great Great Grandmother Charlotte's day, midwives and fathers-to-be would knock on her high bedroom window with a broom handle in order to request her help at birthings. How far we have come! Charlotte, who could not read or write, would be blown away by this technology. I vow to use it for the greatest good. Much love to Mitchell and Daeman. I thank you from the bottom of my heart.