Sunday, January 31, 2010

New Look

Hi all,

Welcome to the new format! I got a few comments about how hard it was to read the white text on black background. I am here to serve you. My husband and I have hit 40, and we have noticed we are becoming a little cliche in that our eyesight is just not getting any better. We find ourselves pulling our books further away or closer than usual, trying to find the places the words don't blur. And forget about the fine print. Reading white on black is apparently much easier on the eyes of the seeing impaired. I know reading that way is easier for me. But hey, I am writing it, not reading it, and if black on white is what readers want, that is what they get!

Thanks everyone who took the time to write me and mention their issues with the colours. I appreciate the feed back! Hope this is easier on your eyes...Young'ens...LOL!

Things That Make you go "Hmmmmmm".

1) Do you NOT find it flummoxing when you know a woman will deny herself no more than one lousy decaf every day whilst pregnant? That she will let nary a piece of delicious, fresh sushi roll pass her lips for fear of making herself and her baby ill? How about wine? Not a drop after the first trimester, "just in case". Let's not forget unpasteurized cheese. Evil stuff. In some places, offering peanut butter will get an eyebrow raised at you, as if you have just offered to create an allergic child who will need an epi pen for the rest of his life.

Yet this same woman, when in labour, will go to the hospital with the advice of her friends ringing in her ears, "Girlfriend, you GET that epidural as soon as you feel any's your right not to suffer!" And she will have no compunction about getting jacked up on all kinds of narcotics and synthetic hormones and procedures that have KNOWN, IMMEDIATE and possibly LONG TERM effects! At what point does this disconnect happen?

2)Women are tough. We are built to be able to weather the trials of reasonably normal labour, even long, hard labour (to a point, obviously). Is it not a physiological reality that endorphin release during labour makes a woman sleepy looking and internally focused, often quite out of it during labour? And that when the fetal ejection reflex hits and the baby sets off all the right "push" alarms, a woman will expel her baby even if she's been up all night or even 2? Seems to me, there is quite a rush of adrenaline that takes over in normal labour, making a mom capable of pushing out her baby even if tired. If there is no evidence of true maternal exhaustion, why interfere? This should be common knowledge to those who care for labouring women, being up on physiology and all. So why is it the second a woman expresses being tired a nurse will say, "I know dear, and we don't know how long this is going to take. You are going to need your energy to push out your baby. At least an epidural will help you get the rest you need to push out your baby properly. You want to have enough energy to care for your baby, don't you?" So introducing narcotics and probably synthetic hormones will mean the "energy" spared is this great commodity worth all the risks? This is treating women like fragile beings incapable of managing their own experience. Besides, even if a woman is sleeping during an epidural, the quality of rest is sketchy, because her uterus is still working hard to get that baby down while she is checked out of the process. Her baby is still working, probably harder and longer in most cases, to navigate the muscles and passageways whose tone is affected by these things in Mom's system.

Again, just to qualify, this is NOT referring to mothers for whom pain relief and hormones are a necessity to help a truly dysfunctional labour. In these cases, the benefits of these interventions probably outweigh the risks and we lovingly support the mother for these choices. In fact, they can help reboot a labour and actually make things more efficient. I'm talking about intervening in normal, straightforward birth.

3)I was asked by an older, male doctor how many babies I had myself given birth to. He wanted to know this, because he felt it made me qualified to help his patient "deliver". I stared at him in disbelief, and again, he asked me, "How many babies have you given birth to? Are you qualified?" I snapped to and replied, " about you?" I wonder how many babies HE's pushed out to make himself so qualified?

4)A friend of mine was the doula at a birth. A lactation consultant was in the room, taking notes on the birth. After the baby was born, at a certain point, she "initiated" breastfeeding. All kinds of information was thrown at this oxytocin/endorphine filled mother, and the baby handled and manipulated in attempts at getting a perfect position and latch. How "successful" do you think this baby was at nursing for the first few days? Try initiating breastfeeding with a mother lamb or cat. Watch how well things go.

5)Baby does not know the thing flopping randomly in front of his face is his hand. Chances are, he's not, in his wily little baby way, manipulating you into holding him all the time with his cries. My children all co-slept with no real restrictions. Trust me, my 11, 15, and nearly 18 year old are in no way interested in creeping back in. They do get out of there eventually, no worse for wear. In fact, they are fabulous sleepers now, comfortable anywhere they lay their heads. I am actually very happy my sweet 4 year old still likes to come into bed in the mornings, and sometimes at night too, for a snuggle. It makes the start of the day sweet.

Just some thoughts for the day.

Have a lovely Sunday.

Saturday, January 30, 2010

Thank you, Thank you!

Wow! I am just gobsmacked by all the super positive feedback I've been receiving about my posts. I really appreciate all of you who have taken the time to comment, share your stories, and ask me questions.

My intention to blog was to put feelers out there to see what kinds of subjects would spark some discussions or move people's hearts. As I've mentioned, I am actively writing my book Choosing Wisely: A Doula's Guide to a Happy Birth Day. People have been encouraging me to do this for years, and now that blogging has become habit (and a very happy one, indeed), so has chapter writing. Blogging has helped me identify what tone to use, and what makes women respond. I have spent many years gathering information, knowledge, and experience around birth. My doula work is my form of activism. Writing is my tool to express what I've learned. I have chosen to submerge myself fully into the field of the nitty gritty work of the doula (I just had a lady say while I was leaving her home after our postpartum visit, "oh, Lesley, by the way...thanks for spending all that time cleaning my poo off the bed" poo being an act of love too). I've observed and helped with the pain and ecstasy of the experience, witnessing the very best and the very worst of what birth attendants and hospitals have to offer for women and babies. I have become full to bursting with stories and ideas.

It has taken me a long time to sit with stuff, developing discernment and good judgement about what to keep and what to let go of, and am finally discovering the right words to bring to the people for teaching, growing, and healing. Word Medicine is a powerful tool, and finding the right voice to communicate with is essential. I'm a Virgo, my planet being Mercury, which means, if you put any credence into it, I gravitate towards service and communication. I've always wanted to write about my doula work, but didn't want to do so yet only after a couple years of practice, or without a clear vision of what I'm doing and where I'm going with my work. My path and my vision become clearer as I go along, and I hope that clarity creates a strength to my voice. I'm the type who didn't even think about teaching doula work until I had been practising for nearly 10 years. I didn't want to write a book that was a rehash of the many great and wise voices already out there. I wanted to have something to contribute, based on things I had SEEN and DONE, not just on what I had studied. I think now I've seen and done a fair bit, and feel okay about putting it out there.

All of your feedback makes me feel a little more secure about putting myself out there. Part of me is always worried someone is going to say, "You windbag! Who are you to talk about this stuff? What do you know?" But as time goes by, I see that I am a windbag, it is true. I AM nobody to talk about this stuff, and the more I learn the more I know I don't know nothin'. So why the hell not take the plunge and write anyway? May as well. There is room for my voice, as there is for everyone's.

Have a wonderful weekend, and thank you, thank you, thank you.

Friday, January 29, 2010

...And While We're on the Subject of Numbers...

...who cares much about the number of centimetres a woman is at? It is a guide, like timing contractions, but in no way the be all and end all of diagnostic tools in most cases. I am irate when I'm at a hospital and a woman won't be "admitted" because her cervix is 2cm and she's behaving as if in active labour. So we spend the next hour or two in triage, around a zillion other couples staring at this woman who's clearly "not coping well", sucking up projected scorn from an eye rolling staff who thinks she's just being a wimp and that this labour will probably go on forever, giggling about how she says she doesn't want an epidural now but will succumb to the flock any time now, until she is rushed into her private room "surprisingly" fully dilated, everyone exclaiming how fast she went. I can't tell you how many times I've seen someone go through this. She is not allowed the dignity of privacy, because her cervix isn't matching an expectation, this privacy being something to help her labour more comfortably. I understand hospitals don't want to admit women who are not in established labour, and that way too many women come in too early and clog up the hospital, so they get stricter about admitting. But just OBSERVE the woman! If she's maybe making some good noises (or focused intensely on breathing), is not chatty and worried much about social niceties, looking like she's wanting to be undisturbed during contractions and bothered very little in between, and seeming deeply internally focused, maybe, just maybe, she's ACTUALLY in active labour, whether her cervix is behaving numerically or not. And if she's been at home for a really long time doing that work intensively, and at the hospital her cervix doesn't open more after awhile, maybe she SHOULD be there, just to have her baby checked on periodically, and in a private room to help her cope with an obviously challenging labour more comfortably. Compassion and dignity go a long way in potentially preventing more "stalling".

I refuse to buy into the hype that a cervix HAS to be a certain amount of centimetres open before a woman is considered in active labour or not. I have even had experienced caregivers say, "A woman is never in active labour until she is 4cm." Often, but not always! I have seen women who are less than 2cm in howling active labour, yes, first time mothers, and they birth within a couple of hours. Conversely, I have seen women at 9cm NOT in active labour, I swear. It's not a common occurrence, but it happens. I've had a couple ladies come into the hospital at 9cm, feeling great, not looking like they're even working hard, and then they seem to have a labour that looks like it gets progressively stronger, longer, and harder, until they deliver 12 hours later. It just happened they had very open cervixes, but the uterus needed to catch up in order to make its expulsive efforts. Of course, they were told all kinds of things were terribly wrong and that labour was dysfunctional yada yada yada, but can't there be circumstances in which a woman's labour is unusual, but in fact normal for her considering she and her baby are fine? I'm not saying a woman shouldn't be observed and their babies listened to and thoroughly checked out when things aren't within the usual range of normal, but she shouldn't necessarily be pathologized either. Hitting a lady with those kinds of words is bound to have a negative effect upon her labour.

The effect of Friedman's Curve superimposed upon a healthy labour does just as much to unnecessarily pathologize it by its very expectations as it does determine a real problem. Perhaps even more so. There have been times I've wanted to shout, "Phooey on YOU, Friedman...and your little curve, too!" But why blame him? He just did a study. It's the people who run into the labour room with the curve on a sheet of paper, poking at it and telling the mom while she's trying to contract in peace, "See? You are HERE! And this is how far you have to go!" which aggravate their patients to no end. I suppose it's their way of trying to provide a container of security by helping a mother know a timeline, which, admittedly as a culture, we are obsessed with. But really, what it serves more to do is create a strong want for drugs when things rarely fit into this time line. As we all know, these have their own risks and repercussions, and usually contribute further to complications, whether obviously or subtly.

I am absolutely blown away by the audacity of some primary caregivers who announce to a woman who hits 4cm that she will go now on average 1cm per hour until she gives birth. This is just the wrong thing to say. If a woman is at 4 and looking like she's way farther along than the beginning of active labour, it might actually be a lot faster than that. I commonly see awesomely contracting first time moms go from 4 to 10 in less than 30 minutes.Telling her she still has 6 hours to go in that state is a sure fire recipe for an epidural request. A mother who is chatting happily and having really mild and far apart contractions might get her hopes up if she's told this information, only to be really discouraged 12 hours later when she's around 5cm and things are just starting to get challenging. Of course she'll doubt herself and think she needs pain relief. Also, this mom is probably going to be told she's not progressing properly and might end up in surgery unless "something" is done.

How would the practice of obstetrics change if only a woman were told, "you are doing just great where you're at" and were provided support instead of projected expectations upon something that's about as predictable as a hurricane?

If most birthing women only realized how this numerical expectation contributed to their intervention roller coaster ride and their feelings of subsequent failure that their body didn't work properly, we would create a different birth culture. If only we could harness the magnificent power of Medicine and be able to apply it in ways that didn't routinely harm birth, it would be a different world, indeed. If I had a dollar for every woman who is told "your labour is dysfunctional and your baby is in potential danger," I would be rich. I find myself in tears thinking about the amount of women who think their bodies failed them when in most cases, this was the farthest thing from the truth and they are berating the wrong party. While Medicine most certainly saves babies' and mothers' lives, and we ARE supremely grateful for those skills and the compassionate way they are usually used, it is frustratingly also the very same system who takes a perfectly beautiful, sacred, process that works well most of the time, and f***s it right up.

We don't measure rose buds with our fingers, pinning down an estimated time of blooming. We wait and trust we will eventually see them flower. Given enough time, space, love, and nourishment, most women will birth. Sure, be vigilant. But don't be frightening, making a woman feel like she's stupid and endangering her child for continuing a labour because her cervix is unfurling in its own gentle time, in its own wise way, not caring a whit about a curve.

Now this is not to say vaginal exams are never important. They have their place and appropriate usage, just like any other tool. But it is, and make no mistake about it, an intervention. It is surprising to many people to know that many midwives do NOT use this as a routine tool. There are those, bless them, who trust the woman's spontaneous progress, and that she will know when it's time to push her baby out without filling her mind up with images of swollen and damaged cervixes because she is uncontrollably bearing down without having intellectual information about whether or not she's "fully" dilated. Do you know how many women still believe they need a doctor to check inside them to tell them whether or not they have the right to push their babies out?! And others are filled with threats and fear about damaging themselves if they don't stop pushing, even if they couldn't if their lives depended on it? I have first hand experience with not having had vaginal exams in my normal births, having had a midwife who, though she would absolutely have intervened appropriately if she needed to, trusted me enough to give me the space to own my own birth and catch my own baby.

In some ways, we are still in the Dark Ages. With all our advanced knowledge and gizmos and life saving technology, we are still in our culture pig ignorant about birth and how to effectively hold it to create the best birthing outcomes. The evidence of that is in our bad birth result stats when compared to other more birth enlightened nations, and a country full of traumatized, wounded mothers, fathers, and babies. We need to do better.

Thursday, January 28, 2010

Throw Your Clocks out the Window

One of my pet peeves is the fact that the most widely used tool parents-to-be are taught to use to determine the progress of labour is the great "timing the contraction" ritual.

When a woman begins to feel like she's in labour, what's the first thing she's taught to do? Time the contractions. What is UP with that?! To what end? In most books and in most classes, women are taught to go to the hospital when their contractions are 4-5 minutes apart, are lasting 45 seconds to a minute, and have been doing so for a couple of hours. Not being able to speak through them is also suggested, but people get so caught up in those numbers, they ignore that second bit of advice.

I tell people to NOT time contractions, at least for the first part of labour, anyway. It's a tool, like any other, but should never be used on its own. What's the best way to make something "bigger?" Pay all kinds of attention to it, and worry about whether or not your process is comparatively normal and "fits in". So by the time contractions hit the magic number (if they ever do, as some don't), a woman thinks she's really getting somewhere and is usually figuring she's in some kind of active labour when she gets to the hospital. This is because the numbers game has set up an expectation, which, in my years of experience simply observing labour, can make for harsh reality checks. Women who are taught to time their contractions as the primary tool for determining how labour is progressing often are the ones who end up saying, "my labour was SO long! I was in labour for 36 hours!" (which is actually not abnormal for a first time mom taking into account all the contractions). Those who choose not to pay much mind to their contractions until it is clear they are absolutely requiring attention tend to perceive their labours as shorter and more manageable.

Lots and lots of women walk into that hospital chatting and smiling, able to analyse their contractions, misled to believing they're just a few hours away from birthing, because they've been given a formula within which to fit their labours. Then when they're examined and told they have ages to go, they get discouraged, and the cascade of intervention begins. How disheartening it is to think your cervix "must" be at a certain amount of dilatation, and you discover in truth, you are only just starting out. Women end up believing they are defective in their birth giving capabilities, when it's simply not true. It was just the expectation that was not realistic.

I have had women call me saying, "My contractions are 2 minutes apart! I guess I should go to the hospital now, right?" I'll ask, "Are you having one now?" And they'll answer, "Oh, yes, I'm having one now while we speak." Well, just because one is having frequent contractions doesn't mean the baby is coming! I will be encouraging and tell her she's doing great, but that if she can talk through her contractions, it's probably better to have a bath and go to bed. Even though I educate all my ladies about how not to use timing contractions as a reliable tool for diagnosing labour progress on its own, it is so pounded into our over-thinky, information obsessed, numbers loving brains, it is a very hard concept to let go of. We are terrified our babies will fall out of us unwittingly at home or en route if we don't keep track. Many first time parents are so afraid of not making it the hospital on time. While very fast birth is possible even for a first time mom, the VAST majority of women go to the hospital too early as opposed to too late.

Let's also stop to consider those whose contractions never get closer together than 5 or 6 minutes. I have seen this happen many times. I'm sure some of you experienced midwives and doulas have seen the occasional woman start out with frequent contractions that go on for awhile, and then it's only when they get farther apart the contractions strengthen enough for the cervix to start doing most of its work. For some ladies, if you wait until contractions are five minutes apart, they're going to birth unassisted (which is not the worst thing in the world for most women..but remember, I work with a mostly hospital birthing population who are very attached, understandably, to being in their chosen place of birth).

Instead of looking at the clock, observe the woman. Listen to her. If a dad calls me and announces the contractions are matching some formulaic expectation and I can hear the mom chatting excitedly and barely cracking a sweat during the contraction, I tell them to stay home if they can. Very often they'll call me hours later, and even though the contractions may or may not be different in terms of length and frequency, I'll hear a change. She will be vocalizing in some way, or doing some very focused breathing...her voice will sound a little far away even between the contractions. If I'm present and watching her, her motions will be slower, and more deliberate. She'll have to lean over things and sway her hips. When labour is really rocking and rolling, most women will look quite stoned between their contractions, the idea of distracting themselves by conversing or watching tv ridiculous, and there is a sense they are far away, off in labour land, and moving normally is often difficult. Plus it's aparent they are feeling some spectacularly strong sensations. For first time mothers, this is usually the time to go to the hospital, because labour has had a chance to establish itself...endorphins and oxytocin are flowing beautifully. If a woman goes to the hospital too much before this happens, it can be EXTREMELY difficult to achieve this trance-like state with all the routines and strangers asking questions, often making the labour seem longer and more painful.

At home is where the woman usually finds her power, and is able to bring it to the hospital with her. Labour usually reaches a pivotal point and becomes a little less sensitive to petering out with the initial hospital admitting routine, though some women are very sensitive, and their hormone groove is easily disrupted. But in my experience, women who choose to hospital birth because it's where they feel safe and go when they're in really good labour, there may be a little lull upon arrival, but quickly labour revs up even more strongly because now they feel safe and settled (which contributes to the beautiful symphony of birth hormones). This is more reliable when the staff are friendly and respectful, doing their jobs as "invisibly" as possible. It is easier to re-establish labour in most cases than it is to get it going in the first place.

So when you go into labour, resist the compulsion to rely on the clock or trust a "curve". Do not mistrust your own sense of when you need to get going. Even the concept of "regular" contractions is not so reliable on its own. It is NOT absolutely necessary to have regular contractions to birth your baby. Some ladies' labours sneak up on them, it's true, but for first time mothers this is RARE. A woman and her partner will usually know that labour is advancing, without little stopwatches and numbers chicken skratched onto scraps of paper. Things feel faster, seem longer, are obviously more INTENSE. With all the other cues labour has to offer which TELL you, "Folks, get somewhere safe and comfortable for you!" you will understand that observing is more reliable than timing.

Because about 95% of my mothers having subsequent babies with me have fast, natural labours, I tell them to let me know right away when their contractions make them double over and go, "ohhhh yeah, I remember this...this is HARD." Because things often move very quickly from there. And I don't care HOW far apart the contractions are. I had a woman not long ago do with contractions about 8 minutes apart. The hospital didn't want to admit her. She had her baby an hour later. TRUST THE WOMAN!

Wednesday, January 27, 2010

Well, look at that! Not much to say today. I am feeling a little tired. I have the house to myself, no children here, no postpartum or prenatal meetings to attend until tomorrow. I think I will leave the mounds of dishes and unfolded laundry, and take a nap. I'm pretty darn sure I will not have a birth today...just a perhaps I will sleep for a few minutes without my phone ringing.

I am very much looking forward to going out this evening for Ethiopian food with a dear friend. It has been awhile I've gone out to do something social and just for fun. It is never easy to find balance in one's life when you know at any moment you may have to adjust your entire day. I personally like this kind of life...I will have plenty of time for routine and stability when I'm too old to doula anymore (like 109 or so). But getting in time for all one needs to maintain a balanced life, like consistently healthy meals, exercise, decent sleep, family/husband time, housework, friend time, and soul work? I'll let you know when I have that figured out. I told an OB at the hospital yesterday my eldest child was almost 18, and she was surprised, asking me how I stayed so young looking, and what sort of facial products did I use? "Vernix," I said. And as for lifestyle, many late nights and a lotta coffee are a major part of my youth maintaining regime.

I have spent the morning working on the FAQ parts of my website, which is coming together more concretely, finally...can't WAIT for it to be done. The masculine counterpart to MotherWit is busy at work getting the infrastructure together while I do the content writing and the woman's work of birth attending. I am very grateful for all the help and advice. I do notice that a man's idea of what a website for mostly women should be like is a little different from mine :) I am going to stick to my guns about certain things, and if it doesn't work, will be gracious about the good natured "I TOLD you so!" Thank God for "computer-y" people!

Off for a snooze. Happy Wednesday!

Tuesday, January 26, 2010

Another Quickie and More on Birth Plans

I awoke this morning with a message on my Blackberry that my client had been up all night with gentle contractions, nothing strong and nothing worth waking her hubby up for, and that they had tapered off. I called her a little later in the morning to check in, and there was no answer. She had gone to sleep for a couple of hours. I was supposed to go out to lunch with a friend, and a good thing she cancelled. Just as I hung up with her, my client called saying, "well, things are picking up a little, as my water has just broken, but nothing I have to do more than breathe a little through. I called my husband to come home." I figured I'd call them in another hour to check in, but 30 minutes later I came out of the bathroom after a 10 minute shower, and there was a message on my phone from her husband, "We are going to the hospital, things have REALLY picked up!" I called right back while dancing around looking for clothes, and the husband said, "She wants to push!" "Shit!" I said. I listened for the gutteral sound of real pushing over the phone, but heard more of a howl of transition. It was her first baby, and they were a 10 minute drive away from the hospital. "GO! I will meet you there."

I called a cab and jumped in. I called them again, and the dad sounded focused. I asked him to put the lady on the phone between contractions if he could, because she was wailing, "I'm so scared!" She took the phone and I said, "Hon, all this craziness is just your baby coming soon. You are going to make it to the hospital. Everything is going just great. You're going to be SO happy really soon." The she threw the phone in the corner of the car as another contraction hit, and I was cut off. I figured I'd leave them alone to focus on getting there, sending lots of good vibes their way. It's not that I have objections to birthing in a car. If it were me, I wouldn't worry too much about it (and my husband more about the detailing afterwards than the actual birth happening unassisted). But people who are planning hospital births generally deeply appreciate making it to the hospital.

I got to the hospital and dashed through the hall, the nurses, who all know me, chanting. "go go go, she's pushing!" And there she was, with a sweet baby's head crowning. So beautiful! I did my best to get her really relaxed, told the dad what a rock star he was for holding it all together, and their beautiful son was soon born. He stayed skin to skin on his mom without any disturbance at all, and latched himself on to her breast soon after. "Well," I said, I would have been really happy to have hung out with you for 24 hours if I had to, but for your sake, I'm glad you're all done." Another happy new family!

I went out into the hall and saw a sweet OB I know and two OB residents I like, both new moms. They all smiled, said "hi", and asked if I was with the fast birthing lady in room 8. The OB said something so nice! "She probably gave birth so great from the therapeutic affect of having so much good preparation and support. I tell all my patients who want to know how to give themselves the best chance of having a great birth to hire continuous labour support...get a doula...but NO birth plans!" The other ladies and I all heartily agreed. They were actually surprised that I was not a great fan of birth plans, because the popular belief is that doulas are helpers of birth planning. I told them I wasn't into the concept of them much, but was curious about why they were clearly against the whole idea.

What was interesting about this conversation, was that these ladies are medical doctors, meaning scientific, studies-loving, efficient, logical people, at least to an extent. And their reason for not birth planning? That committing a birth plan to paper JINXED the birth!!!! I thought this was SO funny, and actually very endearing. I love hearing doctor/nurse talk around the ice machine:). What they explained was that their experience showed them that many of those who came in with birth plans actually had more challenges with birth. It's not anything they've studied, and it could just be they are connecting their experiences with challenging births to their memories of the fact that some happened to have a birth plans with them at the time of said challenging births (not noticing if a great birth outcome had a birth plan connected with it too). I found it very very interesting how vehemently they all claimed they saw a marked (though purely anecdotal) correlation between birth plans and hard births. When I think of the 6 births I've attended this month, except for one planned C-section for breech twins, they have ALL been fast, pain med free, everyone seemed quite satisfied with their hospital experience, and not a birth plan among 'em. What the clients wanted communicated as truly important to them, they were able to do themselves in about 3 seconds.

So, in a nutshell, here's the the medical advice I heard today: Don't make birth plans, cuz you may be invoking the evil eye if you put your visions and hopes of your birth down on paper... LOL! My reasons are just to avoid annoying the staff, and not getting too caught up in expectations...never thought of the "angering the gods" reason! You learn something new every day.

Like I've said before, if someone is really gung ho about writing a plan, heck, I'll help them do it. It's not for me to judge. I just don't think, except for a few very important preferences in point form if they are really concerned about clashing with the staff, it's necessary. But hey, it's your birth, not mine. I advocate choice.

Monday, January 25, 2010

Rebalancing After Birth Attending

I had a lovely weekend, full of births. Lovely for my clients and me, but it's important to remember that when a doula tends to her work, there is often a family missing her. My husband Mitchell works hard all week, so in the evenings and on weekends when I am at births, instead of getting to relax and doing things as a family of 6, he's holding down the fort. Usually on weekends we share the chores of catching up on housework, laundry, grocery shopping, cooking, etc. So when I'm away at births, he takes on most of that, as well as tending to the emotional needs of kids who may have feelings about Mom being away. He's the one who brings them to all their activities. This may make you other doulas jealous, but he often even gets up with me in he middle of the night and drives me to where the birth is. Yes, he gets tired sometimes being a doula's partner, as many do. So it still amazes me after all these years that his support for my work continues to grow stronger. Not that he doesn't sigh in disappointment sometimes when he realizes a plan he had to play some cards with his friends again gets waylaid by my unpredictable work...but he understands that it is somehow an important thing I have to do. He supports that it is my path, that it's simply what I DO. What warms my heart is that he speaks of me with pride. You can see why I stick with him.

I was so happy Saturday night when we attended Carl Bigheart's talk here in Montreal! A woman I know, a friend of a friend whose birth we had the opportunity to support together, who had never met my husband before said, "It is so great to meet you! So you are the person who makes Lesley's work possible! Thank you so much for all you do!" I was very moved by that, and I encourage all of you who know doula's partners to make sure they feel special once in awhile. It is a big job to be the partner of a birth attendant of any kind, and truly, the quality of our work is commensurate to the amount of support we have. I have 4 children, a home, and a dog, and I can leave at any time for a birth, be gone for 2 days, and not have to worry about a thing. How many can claim to do that? I have 2 marvellous teenage kids who help out too, minding the younger ones when my husband and I go out together on occasion, even if it's just a 10 minute drive to Tim Horton's for a coffee.

In order to rebalance my family life after births, I try to make sure my kids have some special attention. I had no qualms today, when we got up and I saw the younger ones looking a little deflated at starting the week without their "mom" quotient, telling them we would all just stay home together. I don't worry about things like them missing a day of school now and again for their emotional health, or occasionally cancelling my day of appointments if they're not pressing. I also keep strict boundaries around my pre/post natal work. Even though it may not be very convenient for my clients, I simply don't meet with them outside of the hours my kids are at school unless it's really urgent. No evenings, no weekends, unless they are in labour. In the end, it makes me a more present doula, as I'm not stretched so thinly and chock full of maternal guilt. It's hard enough for the poor kids to wake up in the morning on occasion and I'm not there where they expect me.

This infrastructure of support has not been easy to come by. A new doula will usually not have the luxury of setting her own pre/post natal hours as she tries to become established in her community, or have a strong sisterhood of other birth attendants to connect with when they need help and advice. Many don't have teenage kids to help with the younger kids when their partners need to go somewhere while Mom is at a birth. And understandably, many partners are just downright resentful of how demanding their lady's doula work is of their own time. Lots of doula careers burn and fizzle because the family simply doesn't have the resources to handle it. I have worked long and hard in order to have a secure system within which to be able to attend as many births as I do (67 babies in 2009, and 7 so far for 2010). I am so thankful for the opportunity to witness so many babies enter this world within the loving environment I try to create out of a cold one, and it simply would not be possible without the support of my family. If I attend a birth that challenges everything I have physically, emotionally, and spiritually, while talking to my sister doulas is essential to regrouping, it is really my husband who tends to my sometimes broken heart. My husband is the best doula in the world.

All right! Enough gabbing. Off to fold a week's worth of laundry while I watch Nightmare Before Christmas with my kids.

Saturday, January 23, 2010


Today is a good day. I am excited to be going to see a talk with Carl Bigheart this evening. He is just a wonderful man who works to create bridges between ancient wisdom traditions and healing of the relationship between human kind and all other beings. My dear friend Nat is organizing this talk, and I want to be there tonight not just to hear Carl speak, but to support her too.

I was nervous when I woke up this morning and discovered I was still in my bed. I had been expecting my lady with broken waters to give birth, as those waters had been broken for quite a long time. She was in contact with her doctor, so everything was fine.

She decided to go into the hospital to get checked out, and I was just so scared I would miss the talk. I had planned to send a backup for a few hours if someone went into labour and needed me during the talk, but it's another thing to leave a mother in active labour...something only an emergency would motivate me to do.

I arrived at the hospital and my client was in tears because she really hadn't wanted any sort of intervention, and here they were, discussing induction. She had already tried homeopathics, herbs, acupressure, and castor oil, to no avail. The doctor was way out of her comfort zone, and was pretty insistent, in a nice way, about getting the labour moving. She checked my client and found her cervix really nice and stretchy and dilated, and assured her that a drop of synto would get her going, and that once her body took over, she could stop the medication, and let labour progress on its own. My client begged just to be able to walk up and down the stairs for 20 minutes. I didn't think that would do much at this point, but then the doctor found there to be still a pocket of amniotic fluid, which she broke. We thought that maybe with that plus a walk, things would start. Remember,trust the woman.

We went to the stairwell, and I encouraged her to walk up sideways, 2 at a time, as I thought her baby was curled up pretty far on her right side. She began gentle contractions. Every time she had one, she squatted down. As it got stronger, she leaned over, looking out a window, and circled her hips. People passed us on the stairs and weren't sure what was going on, but they didn't bug us. A few contractions later she was really working up a sweat, making some noise, and making big, beautiful hip circles. Instead of chatting between, we were quiet, honouring her trip to labour land. And one contraction or two later, she made the noises that made us realize it was time go get back into her room NOW. As we ran by her doctor, we grabbed her and told her the baby was coming. She was surprised, but very very happy.

A nice big boy, nearly 9 pounds, was born less than 20 minutes later, just an hour after the doctor had broken the last bit of bulging membranes.

What is even happier about this story, is that the mothers' first birth had been nearly 2 days long with forceps. This baby practically fell out, nearly a pound bigger than his elder sibling. We are all over the moon for her.

So,even though I've just been contacted by an other client telling me she is having some contractions, I'm pretty sure we're in the clear for the talk tonight! I can't wait!

Happy Saturday, everyone!

Friday, January 22, 2010

Honouring Women's Intuition

One of the sad things about today's care of the pregnant/birthing/postpartum woman is a lack of respect for her intuition. Many women are considered hysterical or completely blown off for discussing their intuitions. What exactly is intuition? It's about looking inside and gathering information about things and situations not by reason, but by feeling. It is not about being psychic. When we refer to intuition, people sometimes think we're refering to looking into the future, which, unless you truly are gifted with psychic ability, is not generally possible. I think intuition just means gathering information about things which are conveyed in ways more subtle than can be perceived by the five senses. I don't believe, as doulas, we can predict how birth will ultimately play out in the future (try to pin Birth down, and she changes on you...she hates us puny humans trying to "know" her too well), but you can, in the here and now, be able to intuit something about a woman, perhaps an emotional or energetic frequency, that can give you a good or not so good feeling about how that may play out in the field of childbirth. And you can be wrong, which is okay, because nothing is fool proof.. not ultrasounds, amnios, or blood tests (oh my!).

As a doula you would never say, "I have a great feeling everything is going to be fine, so don't bother checking that unusual symptom out with your midwife or doctor." Most women wouldn't eschew some form of prenatal care if given the choice, based upon intuition alone of their and their baby's wellness. Some do, and more power to them, but most don't. But just because we usually don't use only intuition to gather information, doesn't mean it should be discounted as an extremely valuable tool to determine things about a woman's experience.

I trust women. A woman in her childbearing year tends to have incredible insight into the workings of her body and her baby. She should be given plenty of space to talk about these feelings freely without fear of being judged as "silly". When you're growing a baby inside you, you are linked to another being more intimately than any other way. It is no surprise that a woman can have very strong feelings about what's going on with her baby. I kinda believe that a baby transmits his feelings to his mom in some cases. I don't think he says, "Mother, I am planning on becoming photographer someday," or "Ma, I will be born with a large birthmark." In fact, many women before the days of ultrasound were unaware they were carrying twins until the day of their birth. I just mean I have seen wild flashes of insight which, in spite of medical disbelief or logic, have been proven right. There are just times a woman tells you something when you know in your own gut what she is saying is know it by a strong feeling of resonance with the truth of her words.

Here are a few examples. A really crazy amazing wild woman friend of mine named Michelle, was my doula for the birth of my first child. She had given birth to her own first three children at home in the mountains of Tennessee, one of them unassisted, I believe. When she became pregnant with her fourth child, she had been doing some doula work in hospitals. She told me she thought she'd birth this baby in a hospital. I asked her, "What do you mean? You've had great home births. What makes you want to go to the hospital?" She told me she wasn't sure, just that she had felt really comfortable in a certain hospital she had worked at, and felt drawn to give birth there. She arrived at the hospital in labour, and was very quickly rushed to the OR for an emergency C-section because of severe fetal distress due a real and serious umbilical cord problem. Her son was fine. And her next three children were born at home in the Dominican Republic.

I had a client once who was SO enthusiastic about water birth. She booked herself a space at the Birthing Centre where her midwife said there was a room for water birth. She even wrote an assignment for a training she was doing on the joys and benefits of water birth. So in labour, there she was in the water. 2 interesting things happened, that were probably unrelated (but who knows?), but I'll mention them both. One thing, was that about five minutes before the baby was actually born, she got this look on her face of seriousness. She looked at me and announced, not with a fearful tone, but just in a very matter of fact way that she didn't want to be in the water any more. She is a joyful lady with a lovely sense of humour, so this sudden change to serious was unexpected. I was surprised, but just got her out of the tub as she wished. She hopped on the bed and birthed her lovely child. That baby had the teeniest tiniest little cord you ever did see! There was no way we could even put the baby on her because the cord was so short. The midwife said, "Wow, that's interesting. Had you given birth in the tub, we wouldn't have been able to lift the baby out of the water." Not that this would have been dangerous necessarily, just that it might have been pretty awkward to get the mom and babe out of the tub.

The other thing was that in the tub while the baby was making its descent into her birth canal, she was sitting in a really strange way. I can't even describe it, except that it looked like she was trying to open up one side of her pelvis as widely as possible. It looked super uncomfortable, but that's how she wanted to be. I did some bodywork with her a few days after the birth of her baby and found one leg to be quite shorter than the other and her pelvis very contracted on the side she had been intuitively opening up in labour. She told me she had been in a bad car accident during her childhood, and had sustained injury to her pelvis, but it was not something she had consciously thought of during labour. But her body "knew", and so most likely did her baby, sending her messages the mysterious ways babies do.

I cannot tell you how many times I've been with women, lots of them first time moms, who are told they are 2cm dilated or so upon arrival at the hospital, but contracting as if in active, not early labour. Often, nurses want to send these women home, because the belief is that if you're only 2cm dilated with your first baby, you've still got many hours to go. But many of those moms announced there was no way they were going to go home because they were sure, because of how they felt, they were moving right along in labour. And it's crazy how often they are argued with, being told they're just not managing their pain very well, and that it's only going to get harder, and they might even "need" an epidural later if they're feeling labour that strongly at "only" 2cm. But I tell them, "you're contracting great! Your cervix is going to catch right on up to those contractions." And so it usually does, proving that for them, active labour can certainly be going on at 2cm, no matter who believes them.

I remember having a client who was having SERIOUS contractions. But they were far apart, like about 8 minutes or so. They were intense enough to make her want to get to the hospital. I arrived, and she was sitting on a bed on a monitor with a barf bowl under her chin, and that really stoned look women get between contractions when labour is powering on. I watched her contract, and though she wasn't making much noise, you could tell it was a really good one. The nurse looked at the monitor and laughed at her, telling her she shouldn't have come to the hospital yet, that contractions HAD to be closer together for them to even consider taking her in. I asked the nurse to check her, just in case, because I had a feeling this mom was in really active labour. The nurse didn't want to, but did. The mom was 7-8 cm, and gave birth quite soon afterwards. I don't put much stock in numbers of centimetres of dilation, but I'm glad for the mom's sake her cervix gave the nurse the numerical "evidence" she wanted to admit my client.

I just don't understand why a woman who says, "I think the baby is coming sooner than you think" is met with arguments against the claim of her own experience. My doula colleague who works primarily with a community that has lots of babies sometimes ends up actually catching the baby in the hospital because the medical staff don't always believe the woman will deliver as quickly as she says she will. If a mother of 8 says, "The baby is coming!", and her cervix gets checked (grrrr) and you hear it's 4cm, believe the mother, not the cm. Put on gloves if the doctors leave the room in disbelief. TRUST THE WOMAN!

A few weeks ago, a lady called me in the morning saying, "I sort of feel something happening, but I'm not sure...just lots of pain or anything. I wanted to give you a heads up." I hung up thinking, because it was her second baby, that things might rev up quickly. Just the sound of her voice sort of gave me a feeling. Sure enough, on my way to a prenatal appointment, the woman called me up crying fearfully that contractions were coming really close together, were intense, she was alone in the house and couldn't reach her husband at work. I booted over there in about 10 minutes to find her on hands and knees making active labour noises. I managed to get in contact with her husband and mother-in-law to make arrangements with her other child, and then I wondered what the best option would be. I was wondering how long we had before this baby was going to make her arrival. Things looked and sounded convincing, and I knew if her waters broke, I'd be catching a baby. Ambulance? Cab? So I figured I'd ask the mom. In a small space between huge contractions, I put my hand on her back and said her name, and asked her to look at me (I normally wouldn't interrupt a woman's concentration like this, but I felt she would be able to give me information I needed). I asked her straight up, making deep eye contact. "Are we going to make it to the hospital?" She stopped breathing heavily, checked in for a second, and said, "yes, we are." So I called the cab. The baby was born about 45 minutes after we arrived, 5 minutes after her waters broke.

I have many many more stories like this to illustrate a woman's deep connection to her body and her baby, but you're all gonna have to wait for my book to come out next year :)
I'm really digging this exercise in blogging, and could go on for hours, wind bag that I am. But I'm going to be making my posts a little shorter in the future in order to make more progress on my book. It's going to be called: Choosing Wisely: A Doula's Guide to a Happy Birth Day.

So, just to reiterate before I retreat back into real life (hyper kids who have eaten too much Friday night sugar, a lady whose waters have been broken all day, and many new client requests to process):

Intuition is often undervalued in our medical system. We need to listen carefully to women, and pay attention to our own feelings as well. BUT, it doesn't mean intuition is all we should use. It is one tool out of many. A primary caregiver having excellent clinical skills and experience AS WELL as good instincts and a gentle, compassionate, honouring bedside manner is ideal.

Night, all!

Thursday, January 21, 2010

A Doula's Basic Guide To Nourishing Your Pregnancy

Technically, it takes very little to have a decent birth experience. Most women can squat in a forest and have a baby without any instructions, never mind interventions. Of course, things happen beyond our control, but MOST of the time, the process works fine. I have heard midwife Karen Strange say, "Birth is meant to work when noone else is there," and I believe that is true for the vast majority of birthings.

As a doula, I know for a fact that many outcomes that have been less than favourable have actually been caused by too much meddling with the process...too much doubt, too many attempts to control all contingencies. And I have also sadly seen not wonderful outcomes when there have been no interventions and there should have been. So, knowing as a reality there truly isn't much control over what direction a birth decides to take, there are ways you can increase your chance of a nice, happy birth. No guarantees, but a fighting chance doesn't hurt.

I've outlined a few steps on how to nourish yourself during pregnancy and beyond. Nourishment is a concept that goes far beyond just what you put in your mouth. It refers to anything you "digest" physically, emotionally, and spiritually.

1) Eat well.
Eating well is a very important aspect of prenatal care. It cannot be emphasized enough that good nutrition is essential to creating the best chances for the best outcome. I have seen women heal symptoms from the annoying to the dangerous by adjusting her diet. Your baby's optimal growth is dependent upon the food you take in. Yes, I know, even ladies in very poor circumstances can have reasonably healthy babies, but we're talking about optimal health. It's not hard to eat well....eating organically as much as possible is preferable, but if that is not possible, many find that simple, healthy food is actually a lot cheaper than processed food. Why not give it a go?

2)Exercise gently
Walking, yoga, swimming, bellydancing...these are all ways not just to nourish and tone your body and make you strong and supple for birth, but to help you connect more deeply to your centre. These exercises put you in a more meditative state, perhaps helping you discover areas you hold tension, and help you work through that tension.

3)Receive loving touch.
Massage, osteopathy, shiatsu, chiropractic...all of these things help you relax, aid in balancing and aligning your body, and work out aches and pains. They can also help you with somatic/emotional integration, as what often happens with receiving bodywork is a greater awareness of where unprocessed emotions tend to live in your body.

4)Gravitate towards those you have the best relationships with.
Loving, nurturing relationships are crucial to the wellbeing of the pregnant woman. Laughing with good friends, chlling with your mom, having great sex with your partner, consciously tending to and being tended help you grow your baby in an environment of love. If you're having challenges in your primary relationships, it's important to have a safe space to talk about these issues. If there were ever a time to get on top of challenges in your love relationship, now would be it for you and your partner to actively work on problems, either together intentionally, or with the help of a good counsellor. Things won't get easier after the birth of the baby. Being on the same page and figuring out each other's values surrounding parenting is something that should be worked out.

5)Work with your emotions.
Take inventory of some of the things in your life you'd like to explore, like fears around your changing identity from regular old you into a mother, fears about childbirth, or patterns you've outgrown but haven't found ways to change. Preparing for birth and motherhood is about creating space. When you can let go of some of the emotional energy you may be hanging onto, you have greater access to the resources you need to give birth and mother in a more grounded way. There are many tools you can use to process your emotions, from journaling, creating art, talking to loved ones, or talking to a trusted teacher/guide/therapist.

6)Surround yourself with beauty.
When your surroundings are clean and comfortable, you tend to feel like you have more space within as well as without. The nesting energy of later pregnancy tends to help us with this task. Taking walks outside in Nature and watching movies or things on TV that are uplifting, funny, or inspirational are probably healthier than subjecting yourself and your baby to the chemical reactions that inevitably occur when viewing something violent. Let the smells that suffuse your home be gentle, natural, and yummy, not harsh and chemically.

Learning to breathe deeply into all parts of your body to receive life giving energy, then breathing out tension is essential to help you achieve deep relaxation. Learning to focus your breath will help you cope with labour and moments of stress in parenting. Having something for your mind to chew on during labour can be really helpful, and breathing is a great tool. Practice it every day. If you are interested in breathing techniques for labour, you can find many resources to learn them. But practice. I find the most useful breath work is deep abdominal breathing, "ocean breath" of yoga, and vocalization to help release the intense sensations of labour. A great prenatal yoga teacher can be a gem to your pregnancy.

7)Educate yourself properly.
Reading a bunch of things about the birth process that are scary or alarmist doesn't really help you. Instead, focusing on positive stories of birth and breastfeeding will keep you less stressed, keeping in mind that stress affects your hormones, thus affects birthing and milk let down. You already know the unexpected can happen, but delving into all the possibilities just "to know" isn't as healthy as perhaps focusing on the couple of things that really stand out to you as frightening. If this is the case, focus on those and figure out what's bugging you and why. Do some emotional work around it to discover what energy is bound up with these fears. Don't let people tell you their horror stories about birth. Your hearing them will not help you "prepare".

Learning your birthing options is crucial to your education. As it's been said, "if you don't know your options, you don't have any." Your doula or midwife should be able to help you with this, and guide you towards the best resources to give you the most practical prenatal preparation education for birth and mothering. If you are being followed medically, talking to your doctor about your options is important to figure out the birthing terrain. Do a tour of your hospital to find out what sort of resources they have to support your desires. The last thing you want to be is vulnerable to medical interventions you don't want by not knowing your rights as a consumer of medical care. Private prenatal education tends to be more nuturing and helpful than hospital sponsored classes, though great teachers can be found here too if you don't have any other resources.

8)Gather support.
If you are going to give birth in a hospital, quite simply, you need a doula, especially if you are hoping for a low to no intervention birth experience and good start to breastfeeding. Hire a postpartum doula to help you build your confidence and make sure you are nurtured afterwards. Ask friends to bring you food if they want to visit. If you've ever thought about hiring help around the house, now would be a good time. Make sure your doctor or midwife are on board with your desires as much as possible. If your doctor or midwife make you feel small for asking questions, even LOTS of them, or don't honour you with straight answers, you probably don't have the appropriate caregiver for you. So CHANGE caregivers. I help people do this all the time. You are entitled to ask questions, and deserve their time of day. Remember, even if your doctor or midwife are truly too busy to give you the time you need (not because they're mean, but because there is a terrible shortage and they need to serve as many people as possible), a doula or good childbirth educator can help you fill in the blanks.

9)Slow down.
Growing a baby is a full time job, and often women work in worlds that look down upon pregnancy, or are not fully supportive of the physiological and emotional shifts that go on. Working right up 'til your due date is not something I normally recommend, unless your job is something that really nourishes you or you simply cannot afford to take the time off (in which case, make space where you can, at lunchtime or breaks). I know that my pregnancies were a very rich time of creative energy, and I needed time to bring forth those creations. Stopping to communicate with your baby inside, taking time to envision your birth, making space for emotional checking in...these are all important aspects of preparing for birth. Imagine working in a stressful environment right 'til the day you go into labour, your head full of "to do" lists and worries about "abandoning" your work? This could make labour...interesting.

10)Let go.
Now that you've done all your work, let it go. Your birth and breastfeeding experience will unfold as it will. The tools you have used to nourish yourself as fully as you can will serve you well to weather your experience. Knowing you did all you could to prepare yourself body, mind, and soul, you own your birth. You have taken responsibility. You have the resources to cope with all the richness and complexity that is your own unique birth and mothering experience.

Blessed birthing!

Wednesday, January 20, 2010

Loving my Doula Soirees!

MotherWit had a wonderful meeting tonight. Though we didn't have a huge turnout (not unusual in mid January), the feeling was great, and the parents who had come for information left feeling informed, nurtured, and calmed. But what made them feel this way was not just the presence of 5 great doulas, but the presence of the new parents. We had the pleasure of having a few couples come with their older babies, and it was they who provided answers to the questions, and they who gave the basic message "hey, we were where you are, clueless and scared, and here we are now, confident and happy." There was a particular moment when a mother with her six month old baby said to the terrified, expecting mother "I was petrified when I got pregnant with Emily. I even asked Lesley if labour was going to feel like torture. And you know what? I ended up giving birth naturally!" Now what could possibly be more reassuring than that? Nothing I could say as a professional could resonate so deeply as this message.

I'm seeing part of my mission as a doula in healing a wounded birth culture is not just going to the births and helping to create good outcomes, but bringing people together so the ones who come out of it feeling like the rock stars they SHOULD feel like, can tell the ones sitting scared, "you know what? No matter what, you're gonna be a rock star too! If I can do it, so can YOU."

Our birth culture is hungry for new stories. No more should women who are contemplating a natural birth be met with the voices of resistance, "are you CRAZY? Why would you not go into the hospital as soon as it hurts and get 'your' epidural?" Can you imagine instead the impact upon a woman with a fledgling hope for a natural birth in a hospital hearing from a new mother, "Honey, of course you can give birth naturally. I did!"? We don't get these stories very often out of hospital birthing moms. But we are starting to more and more as doulas help to contribute to better birth outcomes, simply by honouring the mother's space and reducing distractions, providing encouragement, reinforcing that all the mother is doing to help her body open is great. Messages from new mothers help to deepen that impact, and community grows. Healing spreads. Our stories reflect the healing. As a doula, I am a story keeper, and the more stories I have of beautiful births to share, the more women will believe, "hey, I can do this too!"

Here is how you can contribute to the's not hard, and I encourage you and all your friends to share this message. When an expecting parent tells you they want to have a natural birth in a hospital, don't fill them up with anything negative. Don't say, "oh, it's impossible to have a natural birth in a hospital!" Because you'd be dishonouring their choice to birth where they feel safest. Don't tell them any horror stories about natural birth. I don't think any of my readers here would do that, but if you are in the presence of someone else doing so, intervene with something healing and positive. Instead, fill them with stories of success. You will not be misleading them. Assume they are intelligent and know the benefits vs. the risks of their choices. Allow no horrific stories in the presence of a pregnant woman. It is not necessary as part of her education. Instead, reinforce the great design of her body. Tell her her round belly is beautiful!

Let's let the expecting father know we trust he will know how to come through for his partner, that he will not be the dufus he thinks he's going to be. When I hear my new daddies telling the daddies-to-be, "don't be afraid. You are going to be amazed at how strong she is," this gives them permission to embrace this process as a journey the couple will go through together. So many fathers feel like they're going to be annoying sidekicks, and our culture really doesn't give enough praise to the amazing job the vast majority of fathers do to support their women in labour. My husband was a 22 year old boy when we had our first baby, and there is no way I could have birthed without him, his intuition and trust in me keeping my path alight. Let us change the story that men don't know how to handle birth. Even the ones who think it's icky still can have a profoundly positive emotional impact. So let's build them up instead of scaring them into thinking they're going to barf and faint when they look between their spouses' legs when the baby crowns.

I am tired now, and given to rambling when exhausted, so i will say good night, and go to bed happy, knowing there are a few more people in the world who have reclaimed a little of their motherwit about birthing.

Monday, January 18, 2010

Belly Dance for Birth

What a treat I received in the mail today! Maha Al Musa, creator and teacher of BellydanceBirth, and author of Dance of the Womb, contacted me a few weeks ago, telling me she enjoyed reading my blog on "Control". She asked if she could possibly quote part of it in her classes. After chatting by email a few times, we realized we shared many of the same views about birth. She was so kind in sending me a copy of her dvd, Dance of the Womb. I had the pleasure of being able to take a couple of hours to sit and enjoy it in total.

I have always naturally gravitated towards belly dancing, embracing it as a magic we women can use to create with our sacred hips patterns that help us connect to our ancestral memories and process things in our lives. Maha uses this ancient art of belly dancing to help women create flexibility and strength in pregnancy,to provide a wonderful, effective tool to work through the intensity of labour contractions, and as a valuable way of facilitating easier dilation and birth.

It is a very thorough dvd, so either you can study it as if you were doing a workshop with Maha, following it all in one go, or by chapter, perhaps studying one chapter per day. If you choose to study it in spurts, definitely do the warm up exercises before each time, as they feel SO good!

Dance of the Womb is a JOY to follow. As you learn how to emulate with your hips the sacred patterns of the circle, the spiral, the figure eight, the "cervix dance" (which is subtle, but very powerful), the chest movements and dances of the hands and arms, you connect to a beautiful fluidity. There is one point where Maha, gloriously pregnant at the age of 46, demonstrates the wide hip circle while leaning against a chair. If you have witnessed birth, you will resonate with how universal this dance is, as so many women, if you leave them to their own devices, will feel their thought processes slow and their bodies release, naturally swaying their hips to the timeless rhythm that is Birth. While we cannot control our births, Maha helps us to tune into our innermost selves and use our bodies and breath to help manage the intensity of labour.

There was a small part of me which wished, for a little moment, that I could give birth again just to be able to consciously and joyfully bellydance throughout labour! That won't be happening any time soon, but I did actually receive a great mid back, which has been bothering me for days, felt a lot better after doing the chest circles. As she freely caresses her pregnant belly with her hands and massages her baby with her dancing hips, Maha is a vision of fullness and beauty. But the movements come from such a natural, intuitive place, that she makes every woman feel like they can do it too, regardless of how much "technique" they are worried about lacking. Perfection is not important here..what is emphasized is feeling good while doing it..and it does feel good!

Maha narrates the dvd and gives the instructions in a very soothing voice with her cute Australian accent and allows viewers ample time to play with the movements, allowing us to go more deeply into the hypnotic music that reflects her Middle Eastern roots. Her words are nourishing. They heal us of our doubts about our abilities to give birth. Our hips, bellies, and wombs, designed with perfection, can bring our babies down and out without much help from our minds. By practising Bellydance for Birth, you can get a glimpse of what that magical endorphin/oxytocin suffused labour trance feels like, which transports us to a place where anything, even bringing forth life, is possible.

Maha treats us at the end of the dvd to an interview with the two midwives who attended the homebirth of her baby girl, interspersed with images and video clips of her labouring and giving birth. What I appreciate about these clips is that it is clear there is no promise that Belly Dancing for Birth makes labour "easy" or "painless". Maha and the midwives do not shy away from discussing the reality of pain in childbirth, speaking of it as normal and life giving. We get to see Maha challenged by contractions, and using the Bellydance to help manage the intense energy of the contractions, and releasing tension through movement and breath. We see her allow herself to freely release emotions to help keep the progression of labour going smoothly, and even get to witness as one of her midwives bellydances close to her, as if to share some of the burden, in a beautiful display of purely feminine commiseration.

If you are pregnant and searching for a way to prepare for childbirth, creating space and fluidity in the body and mind is essential, through the practice of BellyDanceBirth and/or Prenatal Yoga. These tools are FAR more important than learning how to look at a clock to "diagnose" your labour progress. Learning how to let go of our big think-y brains and breathe, moan, and dance away our labour tensions are valuable lessons. If you are a professional who works with pregnant and birthing women, Maha Al Musa will be giving trainings in instruction on BellydanceBirth, the Al Musa method, in the near future. I am happy to report that Maha and I are discussing a potential workshop in Montreal next year. So please visit Maha at to keep abreast of trainings and goings on.

Thanks, Maha!

Saturday, January 16, 2010

The Birth of my Daughter Oona

Today is my daughter Oona's 12th birthday. I am reposting this blog in honour of her exhilarating and magical birth. Enjoy.

On the eve of my third child's birthday, I feel moved to write out her birth story. Oona is my second daughter, and in the wee hours of the morning, she will be 11 years old.

Oona's pregnancy felt different from the others. My first trimester nausea was quite intense, and I had a lot of food cravings. I used to HATE cilantro with a passion. If it was in anything that arrived in a restaurant, I'd be unable to eat it. With Oona's pregnancy, I craved it, and it now remains one of my favourite tastes. I wanted lots of bitter greens with apple cider vinegar dressing. Green apples were appreciated too. And bacon. Oh, sweet bacon. The only time I didn't feel nauseated was when I ate bacon. Boy, did that ever make my family happy, because it's not a food we eat a lot of! I also craved the occasional sour peach candy, which, to this day, is Oona's favourite sweet. I had an aversion to clothing, so in the morning my kids would laugh because they'd see a heap of all my clothes beside my favourite chair and thought it was hilarious I'd sit there bare naked at night. I had a lot of fatigue...a really deep feeling of tired in my bones. It was hard to get things done. But otherwise, everything went well. My son weaned at 3.5 years, claiming the milk tasted yucky, on condition that I knew he was planning to start up again once the "real" milk came in when the baby was born. He let go of that idea a week before she was born, which made me relieved, because I spent a couple years tandem nursing, and it's not easy.

I am so grateful for this birth, as it healed so much for me as a woman. My first birth was lovely. a homebirth that went beautifully, though the second stage was extremely challenging, my daughter deciding to come out star gazing. I had to squat for 3 hours, intermingled with belly dancing, to get her down and out. My second child, my first boy, was even more challenging. Also occiput posterior, I experienced back labour I didn't have with my first. Back labour, for lack of a better word, sucks. The labour was a couple days long, far harder to cope with in terms of pain, discouraging because I was stuck at 5 cm for over 12 hours (which I know is not that long compared to some I've seen, but for me it is one of the hardest things I've done in my life) and I ended up being asked by my midwife to transfer to the hospital, where I birthed naturally a few hours later. That birth left me feeling discombobulated, like there were some physical and emotional issues I needed to explore, saddened at how profoundly those things, in my case, affected the birth of my beautiful son.

Oona is six and a half years younger than my first child, and 4 years younger than my second. The choice to birth at home was a no brainer. Homebirth was not legal at this time in Quebec, but I knew a very skilled and experienced midwife who was committed to providing this service to those who wanted it, and for her, I am deeply grateful. I had no ultrasounds, ate a supremely healthy diet to correct some blood sugar fluctuations I had, which were discovered by my midwife, as I did no glucose tolerance testing. I was in a great space emotionally, and felt well surrounded by a loving community of women friends. I had become aware of the principles of optimal fetal positioning, and made sure I didn't slump backwards while sitting, as was my usual habit. I was also reading and doing the yoga exercises in the late Jeanine Parvati Baker's book on prenatal yoga. In late pregnancy, it felt great to squat, so I did this a lot when my baby felt well positioned. I was studying psychosynthesis psychotherapy at the time, and was doing a lot of guided imagery work, as well as working hard on old emotional patterns I wanted to transform.
I did this work because I wanted to prepare for the potential for another long hard birth. I wanted to know that if it was as hard as the one before, I'd have the tools to get through it as gracefully as possible. I also received some osteopathic bodywork, which I feel really helped contribute to aligning my body to make contractions more efficient.

One thing I felt was crucial to my birthing was embracing it as a spiritual, as well as a physical/emotional process. I wanted to make that expression more intentional, so I asked my women friends to have a ceremony for me, a Blessingway, in which we sat in a circle, sang songs,and attached ourselves together with yarn to symbolize our sisterhood of birthing women(which was cut so each of us wore a yarn bracelet...the ladies wore them in support of me, and were to cut them off when the baby was born). We shared the most precious moments of our births with each other to create really positive energy, and I was massaged and given gifts of power objects to put around the house to help me remember my strength and power as a birthing woman, knowing I was connected in love to my sisters. I received things I still have today, and am so grateful for them all. Melissa gave me a poem about birth which still moves me to tears when I read it. Vanessa gave me a pair of big smiling lips on a little pedestal she fashioned out of fimo clay, and told me to remember, "loose lips means loose bottom." Brigitte gave me some worry beads, Rachel, a mother of twins she didn't know were twins until the second baby came out, gave me a beautiful drinking glass to remind me we all symbolically drink from the same cup as we are called to the dance of Birth. Heather gave me the thing I think I used the most in Oona's birth, which was a note card on which she had written birth affirmations, given to her by her midwife Gloria Lemay. The one that resonated most with me was "contractions are healthy for me and my baby." Because, as many of you know, it can be easy to forget when the going gets tough. I received other things too, all of them carefully placed around my home.

About a week before Oona was born, I had a very strong aversion to leaving the house much. I felt a little fearful going too far. I was obsessed with keeping things clean, so I spend a lot of time keeping on top of the mess a family of 4 and a big dog can make. I also had a home job doing data entry for a newspaper, as I wasn't going to be able to attend births for awhile. The day before Oona was born, my husband had plans to see a band play at Barfly, a bar/venue not far from where we lived. I really didn't want him to go, because I just had this feeling I wanted him home. I normally never have any problems with him going out for a few hours with a friend, but I really hadn't wanted him to leave. He reassured me, though, saying he had his pager, he was literally a 5 minute walk away, he wouldn't be going until the kids were already asleep, and would not be drinking alcohol. Except for a sink full of dishes, the house was cleaned to within an inch of its life, and I still had a bunch of data entry work to do anyway. So, even though I was grumpy about it, he went.

From about 11pm until 3am, I spent most of my time squatting on a chair in front of the computer, trying to finish up my work. We were a family of night owls. Our kids were home schooled, and both of us had jobs that were flexible with time, so we didn't need to get up early. I was having some intermittent waves of cramping, nothing that made me feel like the baby was coming then, though it made me think I would probably be having a baby in a few days. The weirdest thing was that I was having hot flashes every few minutes. They were intense sensations, but I rather enjoyed them, because they were different. I figured my hormone levels were getting quite ready to have a baby soon. After I finished working, I left my perch on the chair, and went to have a bath with some nice oils. I completely relaxed in there, and practised some deep breathing. All the hot flashes and cramping were gone, and I felt wonderful, ready for bed. Because I took an oily bath and was a nest-y pregnant woman, I scrubbed out the oil residue in the bath with baking soda to make sure nobody would slip in it the next day. Then I went to bed. While I turned back the covers (because when I'm pregnant and ONLY when I'm pregnant, my bed is perfectly made when I'm not in it), I had a strange flash on an image of a really happy little nine month old baby crawling on the kitchen floor. I figured I was really tired.

As I relaxed into a doze, my husband came home. I heard him go to the computer to check his email. Then I had a contraction. A BIG contraction. I looked at the bedside clock: 3:45am. Phew, I thought. I put it out of my mind and tried to get back to sleep. A couple minutes later, the same thing, and then it happened again. I got up and announced to my husband I was in labour. "oh, so you think the baby will be here by tomorrow night?" I thought, given my birthing history, he was jumping the gun a little, but I said, "yeah, possibly." I had another contraction which made me need to focus and breathe and I said, "oh, I am so NOT in the mood to be in labour! I'm so tired, and just want to go to bed!" My husband, who is really good at distracting me with humour if I'm annoyed, got me into a better space. We were in bed, me on my hands and knees, he sitting beside me, giggling. I would have contractions that made me need to stop, rock my hips, and follow my breath, but nothing I would call painful. He did point out that he was surprised how close together the waves were coming.

I felt like I needed to go to the bathroom, as my body was trying to create maximum space for the baby, and on the way started shaking uncontrollably, feeing really cold. I noticed I was bleeding a little, which assured me that I was definitely in labour. Up until then, I still wasn't sure. The contraction on the toilet made me emit a sound that alerted my husband...a mixture of a whimper and a yell. He came running in. "I KNOW that sound!" he said. "I'm calling Vanessa!" Vanessa was a dear friend I had chosen to help support me in labour. But Vanessa was not answering. The next day we discovered that even though she had been sleeping by the phone, she had not gotten the repeated calls because of a wire problem. Mitchell started getting stressed, because he was worrying about the kids waking up with nobody there to hang out with them while I laboured. He tried our next door neighbour and good friend Rachel. No reply! It turned out later that as he was trying to call her, she was receiving a fax from France. I could hear him running around muttering curses under his breath at the fact that nobody was answering their phones.

I went into our office where he was sitting and said, "Call the midwife." He asked, "REALLY? Are you sure you want her to come now?" I said that she absolutely should come, because it was feeling hard to cope, and I wasn't sure how I was going to handle such a long labour without some support. Given we couldn't get touch with my appointed doulas, I just wanted her there. Mitchell dialled and handed the phone to me, but there was no way I could talk to her. I just said, "tell her I feel the baby really low." He hung up and said she was on her way, and I had a huge contraction that made me almost drop to my knees except that Mitchell was behind me and held me up so I was in a supported squat. I felt like I had to push, which was ridiculous, because I was having a long birth. I told Mitchell everything was just far too heavy, and that I was going to hop in the shower to get a handle on myself. It wasn't that I was in a lot of pain. The contractions were totally manageable. It's just that they were really STRONG, and fast. It was hard to catch my breath, and I was afraid I was going to burn out, given that I was going to be having a long birth and all.

In the shower, I felt fantastic. I just allowed the massive waves to roll over me. They made me bellow, "!!!!!!!" with a growly grunt at the end of them. I was not suffering, just thinking this was awfully strong pretty quick, and that I was being a bit dramatic considering I was just beginning labour. I was chanting to myself, "Labour is healthy for me and my baby, labour is healthy for me and my baby." and laughing, because it was so crazy. I started to feel a little faint from the heat, so I hopped out. As I walked towards the bed, I had one contraction I will remember for the rest of my life. It was huge, and painful. It filled me with a vision in my mind of wanting an ambulance to come and run over me to knock me out in a way that wouldn't do any harm to my baby and me, so we could wake up and the birth would all be over, Baby safe in my arms. Just one contraction of abject desperation. I got onto the bed on my hands and knees, and the next contraction alerted me to the fact that I was indeed having the baby. Not hours later at supper time, but NOW.

I saw a little naked child run past my vision into the bathroom, and then she came out. I begged her, "Kayleigh, Mummy is going to push out the baby, and I'm SO thirsty! Please get me some water." So she did. She assured me that my son Misha was okay. He had heard me yelling and had been scared, but Kayleigh, big six year old she was, assured him that it was just Mom having the baby and that everything was okay (Kayleigh had witnessed a couple labours before). He was apparently hiding with his head under the covers. Mitchell had gone out of the room, still trying to call people. I told him to start warming the baby blankets in the oven. The next contraction, I was clearly pushing uncontrollably, no pain anymore whatsoever. I got a teensy bit afraid for a moment, thinking, "the baby is coming with no midwife here. What if something happens?" But I have a guide who seems to come to me when things are chaotic birth-wise in my life, usually professionally. But the voice was here just for me. In my right ear it whispered, "you know, if the baby is coming this quickly, everything is fine." I calmed right down. No fear, and no pain. I called my husband back in the room, and told him to forget the blankets and just to crank the heat in the bedroom, as it was mid January. I pushed, and my daughter went, "oh, here it is! Wait, it's a big bubble!" My waters had not broken, and I was pushing out a big water filled balloon. The image of a giant bullfrog filled my mind. I also looked at the dishes in the kitchen through the bedroom door and thought, "ha, those ain't never gonna get done now!" The next contraction I wanted the head out. There was no pain as she crowned into her water bag. By this point, I intuitively was just lying back against some pillows, which was most comfortable. I pushed a little to move the head out and it felt GREAT when she emerged. We watched a well positioned little baby fill the water bag. My husband looked into my eyes and said, "Lesley, you know about these things. What do I do?" I said, "oh, just catch her," and then as her shoulder came out the water bag broke away in a bug rush of fluid, and there she was, pink and yelling. Healthy. Safe. Born into her father's hands, and put right onto my belly, where we covered her up with lots of blankets. I looked at the clock. 4:28am. 43 minutes from the first labour contraction. We were over the moon. I was in shock. It's over?! But it hardly even started! My husband was so excited, and so happy, "Oh my God, Les, you DID DID it!"

The doorbell rang not long after and Mitchell ran to get it. While he was telling the midwife the baby was already born, Kayleigh asked me if it was a boy or a girl. Because it was so cold, I was in no hurry to unwrap the blankets and discover the baby's sex. I was just enjoying the moment. I figured we'd wait until the midwife came in. She looked shocked to see us all there, and I started babbling in French about how fast it was, even though I usually struggle in French. She took a peek at the baby, and we discovered she was indeed a girl. The placenta was born, and after she had nursed for awhile, we cut the cord. I had not torn. My son Misha stomped into the room and said, "I didn't want her to be born today, I didn't want it to be a girl, and I didn't want it to have brown hair!" and then he stomped out. We couldn't help giggling. He came back in soon, though, drawing pictures for his new sister. We called our nephew Jeremy to tell him he had a new baby cousin, as we had promised he'd be the first to know. Then we called my mom, who was shocked at how fast it was.

When the midwife left, Mitchell went to crawl in with Misha to comfort him, and Kayleigh, the baby, and I tried to sleep, but we couldn't. I told Kayleigh she could lie by the baby and love her all she wanted, that there would be plenty of time to sleep later.

The next morning, I had a dream, and awoke with the name "Oona" echoing in my mind. It was not a name we had considered, but in the dream I had flashed on a young woman I had met at party once. She was sitting crossed legged in the middle of a busy room, just serenely looking around. My friend asked her her name and she looked up at him with a sweet, beautiful Pixie face and said, "Oona." My friend said, "indeed." You know that feeling you feel when you've met an aptly named person? Well, my baby had this same fairy energy, and I announced her name to everyone. My husband said, "really? You want to call her that? We never talked about that name." And I said, because I knew it would sway him, "it rhymes with Baboona." That sold him. He snuggled her and called her his little Baboona, and we've never looked back. Oona is orginally "Oonagh",and from the sources I looked at, it means "fair" as in beautiful, and "healer". I learned later on that Oona is also Queen of the Fairies. I did not know that when I named her, though a more Fae child you would be hard pressed to find.

I buried Oona's placenta by a tree in our back yard in the summer. She grew into a laughing, sweet, easy going brown eyed baby. She nursed well, but was always slow to gain weight. But she always thrived, and has always been healthy, so I just attribute it to her Fairy roots.

Our first year together was an intense love affair. We got off to such a beautiful start, and I swear my Babymoon didn't wear off for months and months. My first baby was about my becoming a woman and a mother, about inspiring me to find my path. My second baby was about discovering incredible intuition, and bringing through a soul who was so familiar, I've known him forever. Oona, my third, showed me what my love looks like, and what the power of intention has the potential to create.

I made Oona a hazelnut torte with coffee buttercream filling and purple whipped cream surrounding the whole thing for her party. She has 4 friends over now for a sleepover. For a present, she wanted purple streaks in her hair. They look quite nice. She is a tiny little girl, a good head smaller than all her friends, who, at 11, are mostly taller than I am. She still loves to snuggle and spend time doing things with me. She loves to just hang out. And she is fierce. She can score four goals in a soccer game, and doesn't let herself get walked over. I am a thoroughly blessed and happy mother. I am enjoying these last few years of precious childhood, because in the next couple of years, she will be transitioning into teenagehood, and I will probably not be as important in her world. And that is well and good. I know our foundation will bring us through anything.

Happy Birthday, Boo! I love you.

Friday, January 15, 2010

To Birth Plan or Not to Birth Plan?

Not to be controversial, but this is an issue that is brought to me all the time. Many sites, when talking about doulas, have listed as one of our jobs "aiding in creating a birth plan". To be honest, I'm not such a big fan of birth plans. I have never found a great birth plan contributed to a great birth. I prefer to focus energy on helping a woman stay home, if appropriate, until she is in ACTIVE labour (which often doesn't have everything to do with how far apart contractions are). A simple "thanks or no thanks" with a smile from her partner when options are presented by the hospital can suffice. That a woman wants to "go natural" is pretty obvious after a time.

Let me tell you my experience of birth plans. Occasionally, the staff will take the time it takes to read it, agree with what you are asking for, and do their best to respect it. Lots of times, they take it, read it, and then go to the nurses' station and roll their eyeballs, saying, "Oh, great, she's here with a BIRTH PLAN!", and I don't mean in a particularly friendly tone. I have even seen on more than one occasion a mother hand a birth plan to a doctor only to be told, "no, I don't have time to read it. We treat everyone the same here."

I think it's important not to expect that all staff members will be happy you were a good consumer and made a birth plan in order to assist them in helping you how you want to be helped. I tell you this, because the importance of writing a plan is strongly emphasised in books and websites. Parents-to-be are often really hurt when their efforts, which they were encouraged to make by books and classes, are not met with enthusiasm. There is absolutely nothing wrong with having an outline telling people what you would like for your birth, and often even hospitals claim to encourage this. In theory. But in practice, I have seen a lot of strong reactions against them. Alas, more negative than positive. This is a surprising reality, but there you go.
I think these are some of the reasons:

1) When people download birth plan templates from the 'net, they are sometimes quite long. And detailed. Given how incredibly busy Montreal nurses are, often taking care of 4 patients at a time, any other detail they're asked to take care of is just another burden. While they're not against having you be happy, the truth is that many of them feel a lot safer with you on epidural, constant monitoring, and synto, to control your contractions. Your ideas, though they will usually try to respect what you want, are contrary to their own beliefs about birth, as some truly can't understand why you may not WANT to be monitored all the time, or not receive an epidural when you start getting louder than normal. A birth plan doesn't change this belief, PLUS gives them more to do in reading it. It may be in your best interest to not risk making a nurse feel, without your intent, more overworked, as well as a bit defensive about the "list of demands". True, we shouldn't have to be responsible for others' reactions when we are presenting something reasonably and with good intentions, but this is your birth....a potential environment of tension may not be a battle you want to fight in this instance.

2)Most of the things you mention are things most reasonably informed people want anyway, so the details of "I prefer to be mobile during labour" or "I don't want an episiotomy unless necessary" become boring for them to read after awhile.

3)Some birth plans are so specific and long, that you may not be thought of as an informed consumer wanting to create the potential for the best outcome possible, but as potentially inflexible, which worries the staff. While the vast majority of couples would not argue with a serious medical decision, sometimes the staff get nervous that if you made this kind of "insurance" against interventions, you may object if they really have to jump in and do something to help you. Part of writing a birth plan may be about the element of fearing potential victimization. Some doctors and nurses get a little defensive wondering that you may be thinking you will be a potential "victim" of theirs, and it could make the room tense. The truth is, you are going in as a strong birthing woman, and worrying you are going to potentially be subjected to a bunch of procedures you don't want is based upon fear. Fear makes you tighten up and doesn't help labour. Okay, neither does plying you with intervention requests, but the former you actually have control over, the latter you don't, birth plan or not. It just could be that going in calm, with the trust that even though there are many different ideas, all want the same: a healthy mom and baby, and that most human beings try to be basically respectful of each other, you may exude an energy that attracts dignified, and conscientious behaviour.

Now, I know some you anti-hospital people out there are shaking your heads at me, wanting to eradicate the "naivete" right out of me, but hear me out, remembering too that I am myself a home birther who attends mostly hospital births. I KNOW unwanted interventions are often done, and that we need to be aware of protecting our experience by refusing many interventions unless they're truly medically called for, without being able to control negative reactions. I KNOW victimization happens. This is, sadly, a price women sometimes pay when they choose to birth where they want technology and medical people available in the instance of an emergency. Even knowing there may be challenges, women still DO choose to give birth in hospitals, and need real, practical advice. There are ways to try to create the friendliest environment possible. From what I've seen, putting the effort into a birth plan creates a risk of tension, and the less tension, the better. Not having one does not create automatic permission to be the recipient of every intervention under the sun.

4)The term "birth plan" is pretty close to oxymoronic (is that a word?), perhaps similar to "ordered chaos" or "friendly fire". Writing a plan, obviously, in no way, shape, or form makes what you want or don't want happen or not happen. Sometimes making sure you have support to make decisions you want, and going with the flow of your labour is better than worrying too much about potential resistance. We simply cannot control those who enter our space in a hospital, or our birth outcome, and I have not seen a birth plan create a better outcome or attitude because it existed. Coming to the hospital in such active labour that there's no space to really discuss things is a better option (providing that is appropriate for your situation) because there is little time for more than a routine once over,never mind a big dialogue about preferences.

Hospital staff members have seen MANY birth plans, and there are mixed reactions when
you present them, from appreciation, to downright annoyance. So if you're going to make one, know in advance that they won't always be met with friendliness. I have even worked at a hospital which has you check off options you want for your care as a form of birth plan, and I swear they never look at them, because they always want to hook you up on a routine IV even if on their plan it requests you check off "IV" as an "option". It is surprising how many things are paid lip service to in order to appear progressive ,even though when push comes to shove, they are not truly presented as "options", but a part of a routine. So you create tension by refusing too. I'm not saying not making a birth plan will render everything fine and dandy, it just doesn't seem to make a huge difference. If someone is really into making one, I support them in doing so.

If you do not make a birth plan, chances are, you're going to be okay, as long as you know your options and make your choice when they're presented. Remembering that you are the consumer, and that you are allowed to refuse interventions that are suggested to "speed things up" or "slow things down" or "lie this way" or "make pushing more efficient", if those challenges come up. If you are feeling extremely mistrustful of the hospital environment, and feel like you are going to be terrified and fighting the whole time, then you should definitely explore the option of not giving birth there. There are alternatives to hospital birth, and tons of resources to help you with that decision. I personally felt like that, if I may share. I walked into the hospital where my doctor caught babies, and while I really liked her because she had let me grill her even with a load of pregnant ladies in her office and agreed to listening to my baby with a fetoscope instead Doppler, I had a deep, visceral reaction to the idea of being in labour there. I researched, and found home birth to be the best option for me. I did give birth in a hospital once, just near the end of the labour, and it was fine. My husband and midwife buffered any attitude that was presented, and besides, I was too far into labour land to notice. People may have told me how to push or in what position, I don't remember. I just, in good confidence, lay on my side and gave birth, pushing in my own way. I have no particularly bad memories. I did not have a birth plan because being in the hospital was totally unplanned.

While I don't think a detailed birth plan is necessary for a good birth, I do think having a couple of really special requests that you have spoken to your doctor about in advance is important, just in case your doctor isn't at your birth (which is entirely possible). To get this in writing simply as something you and your doctor have agreed on may cut through any arguments. They may be things that are not regularly requested at all. For example, delaying the cutting of the umbilical cord, or requesting that your baby remains on you skin to skin for at least an hour after birth. Also, special circumstances should be mentioned. I had a client who had tragically lost her husband during her pregnancy. We made absolutely sure that with every changing shift, she would not be asked, "where is the baby's father?". Another mother who had had a double mastectomy asked in writing for people to not constantly ask her why she was not breastfeeding her baby. I would consider this more a "wish list", which is friendly, as opposed to "birth plan", which may be perceived as rigid, even IF it's qualified by "providing all is well with my baby and me".