Tuesday, March 30, 2010

So Excited!

I'm super excited, because tomorrow I will be meeting with Holly Dressel, who has co-authored books with David Suzuki, as well as done some of The Nature of Things shows. She is an amazingly engaged, involved lady, and an important voice on the subjects of environmentalism and healthcare. Holly is embarking upon a writing project with an OB/GYN friend of hers on the over-medicalization of birth. Guess what doula she's interviewing? Oh yeah, it's me...doing a little happy dance. I promise to represent us in a way that will make y'all proud. I know it's a big responsibility, and I don't take it lightly.

My agenda is to emphasise the importance of the emotional support a doula provides throughout the childbearing year to bring balance to births in higher tech settings (than home), emphasising that for women choosing to birth in a hospital, they can have what they perceive to be the best of both worlds....good clinical care with access to technology if necessary, and attention to their comfort/support needs and solid continuity of care. I will will also dispell some myths that we're all about only natural birth, and explain that we advocate choice. I will also discuss the role of doulas in out of hospital births with midwives, and talk about the studies done by Klaus and Kennel which give evidence of the efficacy of our care. I will mention the important organizations upon whose shoulders all doulas stand, whether or not they are affiliated with anyone in particular, and discuss how our job is to educate and provide proper information, and to be part of a team, meaning we work with the decisions of primary healthcare workers and their patients (our clients), keeping our own agendas out of it.

Wish me luck!

Saturday, March 27, 2010

Need Help with the Madagascar Project!!!!!!

Hello All,

As I've mentioned, I will, providing all is politically stable and enough resources can be gathered, be going to Madagascar in September.

I am now a member of Taratra Reny Sy Zaza, which means "Shining Light, Mothers and Children". This group was founded by the traditional midwives, mothers, and young women of Mahatsinjo, Madagascar, whose mission is to promote women and children's health in that region.

Karen Samonds, family physician Deborah Golberg, midwife Sarah Hunter and I (doula Lesley Everest) will be going to Madagascar to do an educational exchange with the midwives there, as well as hopefully with the doctors who work from the Tsinjoarivo hospital 15 km away from the area we will be staying.

The intent of this trip is to give the midwives some basic equipment (they have nothing), some training in preventing and dealing with complications in the childbearing year, as well as trying to improve conditions in the hospital (which is an 8 hour walk away). Karen sent me some photos of the Tsinjaorivo hospital, and there is basically a slab in the middle of a "delivery"room (and that's it), and a couple of recovery cots. A few basic pieces of equipment, medications, and some training could do wonders in lowering the rates of newborn and maternal death in this region.

This will not be a case of "helicopter medicine", where we Western folks sweep in haughtily, telling everyone they're doing it all wrong, dumping a limited supply of equipment without proper instructions, and then take off with a "good luck". These workshops will be conducted with the utmost respect for the tradition and vast amount of experience the midwives have. The Taratra midwives who are good friends of Karen, who has spent many months per year in Madagascar out of the last 10 years of her life, told her these workshops are something they want. And we are fascinated to learn of how they deal with complications in birth. As a doula, I am really excited to learn about the massage techniques they use to treat infertility, and am curious about how they support a mother in a long birth. Karen told me their approach to birth is very much like that of a doula.

Some of the areas Karen and the midwives have identified as being useful to focus on are:

1) Contraception and STD prevention. Many of these women have more children than they want, and really want to know how to prevent conception. They were not aware that there are more fertile times in the cycle than others. Also, condoms were not something known before. Men tend to have multiple partners, so STDs are an issue. Male and female condoms will be huge on our list of things to bring or have donated and shipped.

2) Nutrition throughout the childbearing year. Malnutrition is a huge issue for the women of Mahatsinjo. They have many children, do not have an adequate diet, work extremely hard, thus often don't have the strength to cope with things such as lots of blood loss in labour. Pre-eclampsia is very common. The diet consists of rice, manioc, and other really starchy things. Some fruits and vegetables are available, but it is not known by the women what can provide better nutrition. Also, smoking and drinking rum are habits that are common, and not known to be harmful to a developing fetus. Vitamin A deficiency is a huge problem. Donations for prenatal vitamins for women and children are being arranged, as well as a workshop in prenatal nutrition.

3) Equipment and skills. As I mentioned, midwifery skills are very basic, and there is no equipment. We're coming up with a list of things that will help the midwives do their jobs more easily, as well as things that will be helpful to equip the small hospital. A hanging scale for babies, tape measures, fetoscopes, blood pressure cuffs, stethoscopes, suturing equipment, drugs to control bleeding, etc. are part of the list, and we are hoping to get all of these things donated and sent over, or to raise the funds to buy them. The doctor and midwife on the team will do trainings to enhance the skills of the midwives and hopefully doctors in this region (Advanced Life Support Obstetrics). Teaching basic neonatal resuscitation procedures as well will most likely reduce the rate of neonatal mortality considerably. There are some books also on the list of necessities that will help provide information to a reader who perhaps doesn't actually read, but learns from pictures.

4) Breastfeeding and infant nutrition. Karen told us that the women there are not aware that colostrum is extremely valuable to the health of the newborn. Breast milk is not seen as the amazing nutrition we know it to be. When Karen arrived in Madagascar with her first child, the women could not believe that a baby could be so chubby and hale with exclusive breastfeeding. Coffee is given to infants in order to "give them strength". Low birth weight and diarrhoea are common causes of infant death in this region. We are hoping basic information about the nutritional and immunological benefits of breastfeeding will go a long way in preventing the extremely high rate of illness and death in young children.

Other topics will arise as we do more planning, but these are the basic things we have been discussing.

What we need is to raise funds! I am putting this out there in the hopes that it will get passed on and the word will get out. Any sponsorship, donation, funding, volunteering of time to help fund raise, etc. will be a blessing. Karen has gotten funding from the African Women's Development Fund, but it is not enough to have the team or the equipment that will make the best of our time in Mahatsinjo. We are asking for help! Information about the Sadabe organization (which was founded by Karen and her husband Mitch, and seeks to find a better and more effective coexistence for Madagascar's humans and its wildlife) and Teratra Reny Sy Zaza can be found at http://www.sadabe.org/ You also have the opportunity to make donations on that site, or you can contact me at info@motherwit.ca I will be putting something on my site for donations soon as well on http://www.motherwit.ca/ We are also thinking of holding a silent auction, so donations of products or services are welcome as well.

You have the opportunity to make a profound difference in the lives of these women and children by helping us provide the empowerment they are asking for to develop their knowledge and skills in caring for themselves and their community. You will be honoured on the Sadabe website as a friend and supporter.

Please pass this on and help us make this trip a reality!

Thank you, and have a wonderful weekend

Monday, March 22, 2010

CAPPA Lactation Educator Course

I just sent off my registration to the trainer of the CAPPA Lactation Education course coming up here in Montreal in April. I am quite excited about this. I am a former La Leche League Leader, have been a doula for quite a while, and personally spent 17 years breastfeeding and/or pregnant (tandem nursing, child led weaning, all that)... so I'm pretty handy with the boob. With this experience along with my perinatal massage work, I have probably had my hands on over 500 sets of breasts, and have educated verbally near twice that. In fact, I teach others how to help with basic breastfeeding. But there is always room for more learning.

I think it is extremely important to keep educating oneself. I occasionally go to conferences on lactation...I LOVE conferences. There is one coming up this spring in Quebec City on Kangaroo Care which I am dying to go to, but am unable because the volume of clients I already have booked up for them. It's quite hard being booked around 8 months in advance, because planning things becomes quite a challenge....I was already booked before I knew about the conference. Anyhow, I was so happy to hear of this opportunity, because there are new studies and approaches always coming out, and I think a birth attendant should be kept up to date. The doulas on my team are also taking this course (except for Kimberley, who is already a board certified lactation consultant).

If you birth workers out there get the opportunity to do trainings here and there, do them! Even if you don't choose to do the certifications (which I probably won't in this case), the knowledge will be with you. You will always learn something. It's important to never get too complacent with your knowledge. If you don't keep up to date, you're going to start having clients ask you about studies and techniques you've never heard of. Thanks to CAPPA, for this opportunity to increase my knowledge base and enhance my skills.

Thursday, March 18, 2010

A Day With Dr. Lewis Mehl-Madrona !!!!!

I want to announce an amazing fundraising event that will be taking place on April 11th, 2010, from 9am to 5pm in Montreal. Dr. Lewish Mehl-Madrona, author of Coyote Medicine and several other wonderful books on the subject of healing ourselves and our culture through storytelling, will be leading a workshop called Birth and Healing: Healing and Birth.

With Dr. Mehl-Madrona, and I quote "we will explore birth as metaphor. Birth is an ultimate symbol for change and transformation. Birth represents a physiological reality in which metaphor and biology meet. Metaphors of release, surrender, 'going with the flow', and energy are all helpful to giving birth. We will challenge the conventional birth crisis stories, embedded in the language 'failure to progress', 'incompetent cervix' being 'sectioned', membranes 'rupturing'. By exploring these metaphors we can learn more about how to help women give birth and how to help anyone birth a new self, a transformation, a change. Midwives and doulas manage energy without interference or obstruction. Healing requires this same type of management. We will explore how the training of midwives and doulas is ideal for becoming involved in all kinds of healing. We will explore through role playing, re-enactments, and other techniques being 'midwives of healing' for conditions other than birth. Guided imagery and visualization will help us in these explorations.

We will explore how giving birth and the work and preparation required to do so, can be healing for women on multiple levels."

Rivka Cymbalist, founder of Montreal Birth Companions, is a dear friend of mine, and MotherWit Doula Care is committed to helping promote fundraising events and gathering donations where we can to support this essential service. This is a message from Rivka to everyone who wishes to contibute to potentially improving a birth experience for a woman of need: "Help us fund the Montreal Birth Companions. Montreal Birth Companions is a non-profit, non-funded organization. We provide doula services to low-income and otherwise disadvantaged women and we train doulas within ethnically or culturally isolated areas of the city. Our goals are to provide women with doulas who are sensitive to particular needs, and to provide low and no-income women with education and a valid means of support.

Our organization is not government funded and relies on donors to provide support for seriously disadvantaged women.

All profits from the Birth Workshop will go towards paying doulas to accompany needy women during childbirth. Larger donations are eligible for a tax receipt. For information see:

Location:Centre Communitaire, 6767 Côte-des-Neiges, Montreal, QC, H3S 2T6
Contact: Rivka Cymbalist
Montreal Birth Companions

On a personal note, I am very excited about attending this workshop. I am big fan of Dr. Mehl-Madrona's work, and feel he has contributed much to my approach to holding the space for a birthing woman. I used to have somewhat preconceived notions in my mind.."oh, that lady was born by C-section...she's probably going to have a really rough birth," or "wow, she experienced sexual abuse in the past. We're going to run into problems." or, "the more emotionally clear you are and the calmer your approach to birth, the more you are guaranteed of a good outcome." Many are aware of the quantum physics theory which states that an object changes according to who is observing it. Well, I knew that giving birth in an environment which uses disempowering language like "I delivered my patient", or "to go through natural birth is barbaric" definitely had an impact on women, but I didn't consider that my having a preconceived story could potentially create self-fulfilling prophesies as well. Though we many not be so powerful as individuals to totally derail a birth with our thoughts, people's energies influence each others', and can subtly shape how a woman perceives her birth giving abilities and her birth experience.

Now when I have clients with serious challenges, I don't project those thoughts at all. Our culture already has enough stories to categorize people. I prefer to come with a clear mind and the feeling in my heart that the intense birthing energy is beyond definition and prediction in terms of how the birth will go or how a woman will cope. We just need to be skilled, clinicians and support people alike, to deal with whatever comes up. I can hold the space for a woman in labour, outline some options, talk through challenges, make her more comfortable, and support choices, but Birth is pretty much in charge. Birth can be a tremendous Healer, bring women joy and empowerment unparalleled. Sometimes, Birth is a tough Mother, and can illuminate areas where we need to grow. And sometimes we cannot interpret it at all..it is up to the woman to make meaning of her experience and our job to connect her to those places she was graceful and powerful where she could be, giving her a richer sense of her resources from which to draw healing.

When I let go of any stories that didn't support the here and now (but rather projected into the future), I saw amazing things. Women who considered themselves "damaged" birthed like dynamos. Women who themselves were born traumatically felt very safe and nourished in labour and had no problems. Some who were hard driving athletes, seemingly devoid of much vulnerability, birthed as gently as lambs. Conversely, some who felt very clear and open to me had lots of challenges. And vice versa on all of those scenarios. I don't think it's because my thought process magically made the birth better, it's more that I probably didn't notice before how great things were going in some "risky" births because I was clinging to my hypotheses, perhaps focusing more on the negative, and creating a story from that. Perhaps my notions prevented me from providing support in a way that could have helped things for the better.

We have tremendous power to change the fearful feelings surrounding birth in our culture. Ina May Gaskin had her finger on the pulse when writing Spiritual Midwifery and Ina May's Guide to Childbirth....half those books are chock full of stories...powerful, amazing birth stories! They're not all sweetness and light...there are stories of challenge and even loss. But they are stories of triumph and compassion all the same. Our culture is starving for these stories. How many times do I reread those stories when I'm pregnant, connecting with those images of power? Ina May and her people at The Farm created their own collective idea of birth as a woman centred, normal, healthy event which could absolutely be achieved with minimal intervention most of the time. They weren't being cavalier either...they believed in excellent clinical skills and medical back-up, acknowledging Birth's unpredictability sometimes. But those few incidents of emergency did not warp their belief. They continued to approach birth with strength, little fear, and positively...they were prepared, yes, but paranoid, no. And they prove this theory of the effect of a culture's positive approach to birthing, balanced with skilled care, with the outstanding statistics they continue to enjoy.

So next time you hear a friend telling another friend, "I can't believe you want a natural birth..you're going to be BEGGING for 'your' epidural the second it gets hard." or "Oh my God, your belly is so HUGE! You should have a C-section otherwise your lady bits will be destroyed!" look your pregnant buddy in the eye, smile, and say, "your body is amazing, and well designed to birth just great!" You can do your part to contribute to our wounded birth culture's healing by not adding to the horror stories. Also, telling a woman who has just had a C-section, "hmmm, maybe if you hadn't had an epidural (or induction, or birthed in a hospital, or had done more emotional work, insert condition here) you wouldn't have needed a C-section, does not promote healing at all. Just because you are on the natural birth boat doesn't mean you are necessarily healing. It's possible your opinions are judgements, and don't help compassion grow, which is what's ultimately needed. We can be both VERY pro natural birth, AND very compassionate and non-judmental towards women who have experienced different birth journeys. To be compassionate is not necessarily to enable what you may think is misguided thinking.

My personal "thank you" to Lewis Mehl-Madrona for having inspired many a period of deep thought for me about the power of story and images in birth, and "thank you" to Rivka for pulling this all together!

If you don't live in Montreal, but in somewhat surrounding areas, like Ottawa, near-the-border towns in Vermont and New York, you should try to make it. You will be receiving a lot of important learning, and helping women having more nourishing births.

Wednesday, March 17, 2010

DoulaWit and Healing

I just had a nice email conversation with a lady whom I am very exited about having in my doula training this summer, and she said, "thank you for sharing your doulawit," which I think is a really sweet, but powerful phrase. MotherWit means "intuitive knowledge" and "practical wisdom", a phrase I absolutely love. I was turned onto it when I read the book Motherwit about Mrs. Logan, an Alabama "granny" midwife. If doulas have a specific brand of wisdom (and I think we do, given our skills focus on being non-clinically observant, intuiting what a woman needs specifically for her emotional and physical comfort), I guess it is doulawit. Thanks to Odette for that. "Wit" is such a great, all purpose word tag. When I cook up a fantastic meal (if I do say so myself), I am a kitchenwit. When I am tired and foggy, I am a dimwit. When I'm being particularly dense (probably while doing taxes), I'm invariably a nitwit. The "wit" I get, though the "nit" I'm not sure, unless it literally means having the wit of a nit (louse egg). You would agree if you saw me trying to do my taxes.

I met a lady yesterday who expressed to me how hard her last birth had been on her, how it had ended in C-section after 60 hours of labour and pushing for awhile. She had really really wanted a natural birth with a midwife, but it's not the way the cookie crumbled. We talked about the epidural she received after a couple of nights up and little progress, and she cried with the memory of the profound relief she felt from the pain of relentless back labour. We validated that epidural. She wants a VBAC this time, but is concerned about going through what she truly experienced as suffering for a long time before deciding upon pain relief. This woman is an athlete...a very tough one, and like many women who are used to punishing their bodies for a result, birth can become a kind of self-competition. While these "pushing through" skills can work extremely well for a normal labour, when things get long and hard, it sometimes gets the better of us. I used to be a VERY competitive gymnast, so I know this firsthand. Just to make a bit of an analogy: One of the girls on my gymnastic team had terrible back pain. She was working on an uneven bar routine, and was so determined to get it perfect, she kept pushing through. She was in tears, talking to herself the whole time, and when people would come to ask if she was okay, she would shoo them away, saying she was fine, just trying to get the routine down...no matter what. Now if she was feeling good and was experiencing that great "burn" and "high" of a fantastic workout with the reward of getting her moves down, fabulous. But to be handicapped by injury, to be an emotional wreck, and to have no end in sight about the amount of times it's going to take to do this routine to achieve the goal of getting these moves just right (and in fact probably won't because the fatigue and injury reduce the likelihood of things improving any time soon), what is of all this "pushing through" about?

What would it have been like for this gymnast if she had had a loving coach who ever so gently took her hands, looked into her eyes, and said, "I know what a trooper you are. You are outstanding. I am concerned about how you're feeling right now. Let's talk about it a bit." And maybe within that compassionate space that girl could get some perspective and say, "you know what? I'm in agony, and I don't know what else to do." And then they could talk about what she really wanted to do, as opposed to clinging to harsh expectations she was holding for herself. Perhaps all she'd need was a hug, a back rub, a good cry, then go back to the routine and get it down after awhile. Perhaps she'd discover a nap was the best thing. The important thing, would be to have someone listen to and care about her.

In this lady's case (the pregnant woman, not the gymnast), the end result of her birth (aside, of course, the beauty of having a great kid and loving motherhood) is lingering feelings of not being sure of her body and afraid of taking up that "routine" again. While she is totally interested in moving through a normal birth unmedicated if this is how it unfolds, that place of misery she experienced, not realizing what it was until she had the perspective of pain relief, is something she is terrified of. I asked (paraphrasing), "what would it feel like to you if this birth could be about allowing yourself to feel truly nourished during labour...not to have the goal of muscling through a hardcore experience necessarily, but to become aware of your boundary between pain that works for you and suffering? What might it feel like if it could be okay for you to not feel like you're punishing yourself physically at the potential expense of your emotional well being, and know that those around you will absolutely honour choices without question, encouraging you when you are happy to move forward, and encouraging if you decide to have a break?" More tears of relief.

My interest is in trying to hold the space for a woman who has experienced trauma in birth or in her life come to decisions that will be healing for her, honouring that the healing process is unique for every individual woman. Some people might think natural, or even vaginal birth is the panacea of healing for women who are traumatized, and while natural birth can certainly be a huge ray of healing light to many with its empowerment and joy, it is not always so. It's so important for us as birth attendants to not project that as an absolute ideal.


Tuesday, March 16, 2010

MotherWit in Madagascar

I am very very excited, because the possibility of finally going to Madagascar is upon me. As many of those who know me know, I have been wanting to do this trip for a couple of years. We are planning to go most likely in the month of September.

The lady behind this amazing project is Dr. Karen Samonds, who is Curator of the Redpath Museum at McGill University (among other varied and wonderful things, such as recent discoverer of an ancient, fossil sea cow!), and mother of 2 lovely girls, both of whom I've had the pleasure of seeing born. Karen and her husband Mitch live in Madagascar for several months of most years and do all kinds of cool things there, like studying lemurs, to put it very simply.

After experiencing the transformative process of childbirth herself, Karen started talking to the midwives in the area she and Mitch do their work in Mahatsinjo, Madagascar, learning a lot about their practices and the issues they deal with. Their approach to birth was something that touched Karen's heart. She told me their thoughts about birth are very akin to those of doulas. There are also a lot of challenges, with very high maternal and newborn death rates. After doing some research and talking in depth to the midwives and mothers of the community, Karen gathered information about the areas of challenge women and babies experience in pregnancy, birth, postpartum, and early childhood, and thought there was a real opportunity for a great exchange of information between some friends from the west (myself and a family physician who catches babies at a hospital here in Montreal included), the midwives of Mahatsinjo, as well as physicians from the area.

The intent of this project will be, and I'm paraphrasing what Karen has outlined for me, a round table discussion about and identification of the main challenges in the reproductive health of the women of Mahatsinjo, and educational workshops by the international participants to complement traditional practices. The midwives are interested in empowering themselves wtih more clinical skills, like more ways to effectively deal with dystocias, bleeds, tears, babies with RDS, etc. As they are the primary caregivers of the majority of the pre and perinatal women of Mahatsinjo, attending virtually all births at home, improving and expanding clinical skills could definitely improve overall outcomes. So there will be an obstetric skills component, as well as discussions on nutrition, birth control, breastfeeding (many many babies die of diarrhea), etc..

If you're interested in reading more about the organization formed by some of the midwives, mothers, and young women of Mahatsinjo, who are in communication with Karen about things they want to learn about birth and accomplish in their community, you can check out this link:
www.sadabe.org/taratra.html , which will explain things better than I have, as well as the other incredible things my friends do there.

This will be fascinating for me, as I always love observing the teaching of clinical skills. Not that I'd use them, but I do enjoy knowing more in detail about the things I observe in the hospital. I'm also very excited to learn about the midwives' thoughts on birth, learning some of their traditional ways, and about some of the unique tricks of the trade they have to support women in labour. I want to connect for a time to their motherwit. Karen told me awhile ago that abdominal massage is often used to help treat infertility, which is a nifty trick indeed. I want to know what kinds of herbs they use to tell my herbalist friends about, what they do when a placenta is retained, etc.

There is a lot for everyone to gain. And of course, I get to hang out for a week with wonderful people in an amazing part of the world. Where we'll be staying is on a camp from which the team Karen and Mitch work with do their research. There isn't electricity. It is very rudimentary, but from what I've heard quite comfortable. We'll be going in what is their winter, so it's apparently lovely during the day, but cold enough to wear a fleece and a tuque at night. Because it's high altitude and winter, the malaria possibility is very low, and a nice thing to know is that there are no man eating anythings, or poisonous crawlies. Sounds like heaven to me!

The plans are still tentative, as we need to make sure the polticial situation is stable, but the possibility looks greater all the time. Cross your fingers for us. This will be some good work. I promise to take tons of pictures.

Sunday, March 14, 2010

Challenges and Love

I used to turn down clients I didn't feel I was a good fit with. I justified it by saying "well, they'll probably get better care elsewhere." But I've stopped doing that lately. I am trying to have the attitude of gratefully accepting those who really want to embark on this journey of birth with me. If someone doesn't vibe with me and chooses not to work with me, great...I am so glad they are able to trust their instincts and look elsewhere for excellent care, which I will most certainly guide them towards if they ask. But in terms of clients approaching me, if they are very much into working with me, even if I have a few concerns about our connection, I will go for it.

The reason for this is because I think if I don't feel like I click with someone, perhaps somewhere in me I am challenged by an unwillingness to stretch my capacity to surrender my attachment to "fun" births (births in which a woman is at least open to the idea of a natural birth). If a woman's desires are so adamantly different from mine, my feeling trepidation about serving her may be reflecting a challenge I have of truly meeting her where she is at, which is fundamentally a doula's job. I have learned that if I stick these situations out, I come to understand the excellent reasons why this mother is making these choices, and have come to respect and honour them even though they were not what I would have chosen. I think it took a long time for me to come to a place of trusting that a woman truly does know where she's at and what she wants, even if it used to seem to me that she was just not "getting" my information. It also took a long time to not hold an ulterior motive and secret ego-based hope that in the throes of labour I can heroically support her so perfectly that she will eschew that epidural or induction.

How am I to know what is better for a lady; a natural birth full of love infused oxytocin and stoner endorphins (my faves), or a planned induction/epidural out of fear? Yes, we know on a physiological level the former choice is often healthier than the latter, but certainly not always. Women struggle with all kinds of different emotional challenges, and it is supremely important, in fact their sense of safety depends upon it, that they can whenever possible call the shots about their choices in childbirth and know they will be honoured. A GOOD birth, however that woman experiences good, is my goal. But as many of you senior doulas out there know, it's not always easy to surrender your ego and serve from a place of true humility. Interestingly and blessedly, what I've found is that instead of feeling wounded by a ton of births in which people were stuck to ideals I initially thought were "misguided", I have been enriched. I have witnessed first hand that many of the times I have secretly thought a woman was being overly neurotic about something or making unwise choices, she was actually being guided by very deep intuition. It has been so incredible to witness this.

On my plate right now are women struggling with some intensely difficult situations. This is what has come upon my path. I will be attending a birth soon of a disabled child who will be given up for adoption. Many would utter expressions of shock, but I cannot express to you how the path to this choice for this beautiful couple has been paved with hearts so full of such love and compassion, it moves me to tears. I feel so honoured to be part of this process, to hold the space for this couple to say hello, and then say goodbye, sending that child off with blessings for a wonderful life. I have seen so many things in my career I would perhaps have judged harshly from the outside until I have been involved with the people in the situations, seeing them walk in those shoes for a time. It becomes easy not to judge as the relationships I forge with my clients deepen, and grow into something strong and loving. When a doula can meet her clients' issues and choices with unconditional love, drawing out her strengths and beauty, she is truly working from her heart.

The most beautiful thing a client ever said to me as I was hugging her "goodbye" after our last postpartum meeting was, "you've made me feel so loved." She had had an induction, an incredibly long, difficult birth, and a C-section...she had worked with such grace and dignity and it had been nothing but an honour to tend to her. Knowing she had felt loved by my apprentice and me cemented to me how love is truly the cornerstone of our work. If there is any defining vehicle with which a doula serves her clients with the greatest clarity and integrity possible, it is love..

Thursday, March 11, 2010

Educating Doulas

I am very pleased to announce that four whole months before it even starts, the MotherWit Birth Doula Training is just about filled to capacity. Soon, all spots may be filled, some interviews still pending.

For all of you who really wanted to attend but couldn't because you lived in let's say Alaska or Timbuktu, don't despair. I love to travel! If you are willing to host the MotherWit training in your area (hosting meaning setting up a suitable venue, helping us gather together a minimum of 10 participants, and letting us know about good accommodations, etc.), you get to train for free. Depending upon where you live, it will either be a six day intensive, or 2 three day workshops.

I offer apprenticeship here in Montreal, which I believe is a crucial aspect of growing into doulahood comfortably, and am beginning to set up a network in which experienced doulas can provide mentorship to novice doulas in their area, who so badly need to be shown the ropes of the local hospitals and witness firsthand, without the pressure to "perform", the power amazing senior doula care has to potentially make a birth experience a great one. I believe mentorship, which I have been providing for years, is one of the missing links in increasing the confidence and skills of new doulas with nurturing support...doula-ing the doula, essentially. For trainings which don't provide the opportunity for mentorship, it is not too hard to get it. You can network with known doulas in your area, and most will probably be quite happy to allow you to shadow them a little to their pre/post natal meetings and births. If it is not possible, asking your doula trainer how you can go about at least getting phone or skype support periodically is probably a good idea.

Women come to the path of birth attending from all different back-grounds, and there are many wonderful trainings out there to meet the needs of those who are inspired to do this work. I so honour the big organizations like DONA, CAPPA, ICEA, ALACE, etc., who have worked tirelessly to promote doula care on a global level, provide training and emphasise safe scopes of practice. To all of you who are involved in paving the way for doulas far and wide, thank you, thank you, thank you! You are creating the potential for better births, and this so vitally important! There are also more specialized trainings, like Hypno Birthing Doulas, Lamaze Doulas, Bradley method doulas, Birthing From Within Mentors, etc. There is so much richness for potential clients to choose from, and to know they will be well supported in their transition into parenthood within the context of support they desire is very reassuring indeed.

I think standards of practice can vary, providing a doula does not provide skills which are considered clinical (and could potentially harm a client). Many people have varying opinions on that, and really, since there is no licensing, as long as you follow the outlines of the organizations you're associated with, there is room for variance among organizations.

I am just a small drop in the bucket. I'm just a woman who loves birth, got my doula training in a 2-3 day workshop like everyone else, committed myself to continuing my education through massage etc. to widen my knowledge base, and have been blessed enough to have been invited to hundreds of births. I feel I've learned and experienced enough to provide quite a thorough training, but I think it's important for a doula, when deciding upon what training to embark upon, to follow her heart. She should choose what resonates most with her. Some prefer to be certified by a powerhouse of an organization, some like to learn a few extra skills along the way, and some like to go a little more grassroots. It's all good. Just ensure you are being taught clearly what is inside and outside of a now pretty much universally accepted doula scope of practice, good knowledge about the process of birth and how to support it respectfully no matter what a client's choice, a bit about how to put yourself out there in the world to get clients, and how to relate well to the primary caregivers you work with. It is an enriching path, and there is such a wealth of knowledge and support out there. HAVE FUN! It is the most amazing job in the world.

Saturday, March 6, 2010

A Path to Good Doula/Midwife/Medical Professional Relationships

On the heels of my last blog "Doulas Behaving Badly", having acknowledged that we doulas understand why midwives and medical practitioners (OB/GYNs, family doctors, and nurses) are often wary of embracing us as valuable members of the birth support team, I would like to now put forth a few points to help you understand doulas a little better in the hope of bettering our relationship.

My intent as a primarily hospital birth doula is to help a woman understand her birthing options in the hospital given the policies of the hospital she chooses, encourage free flowing patient/medical professional communication, help the couple clarify their values surrounding their childbirth experience, empower the couple to make decisions based both upon those values and their needs as discussed with their midwife/medical practitioner, then support those choices. My prenatal appointments are geared towards taking a thorough history of each woman, figuring out what the couple fears about birth, filling in some of the gaps they may have in understanding the birth process, gauging her emotional state, getting a sense of her relationship to stress and pain, knowing what resources (both internal and external) she has access to as well as guiding her towards using and expanding (if necessary) those resources. Our extensive prenatal work is geared towards building confidence in her ability to give birth normally, as well as helping her partner feel good about his/her role in supporting her with the challenges of labour and parenting.

During birth, my job is help the woman and her partner ride the waves; the waves of contractions, the waves of hospital shift changes, the waves of questions and explanations, and the waves of emotion. I am their anchor. The unique rapport I have built with my clients helps them to navigate these waves of the unknown with the comfort of an experienced "surfer" as a guide. My presence helps the couple from being swallowed up and swept away, which is a very easy thing to happen systematically in a big hospital full of people who are comparative strangers. Please understand this is not a personal criticism of any medical/midwifery practitioner. In fact, most of the practitioners I work with acknowledge this impersonal care to be one of the challenges of hospital birth. This does not mean it is a place that lacks compassion and kindness. Not in the least. It just means that the way the duties are set up for hospital staff members, the intensive attention a couple needs to good physical comfort and emotional support is not readily available.

I have had nurses be brutally honest with me, which I appreciate. Some have explained, "It's not that most of us are opposed to natural birth (though some are...they are taught about the dangers of birth and the superior value of medicine, so it makes sense some of them are mistrustful of that natural process), it's that with all the work we have to do we just find it easier to have a woman on an IV, monitor, and epidural. If something goes wrong, we're prepared. Also, because we have to divide our attention among several patients, we are relieved to know they're not suffering with their pain." I totally understand this given where they`re coming from as well as their crazy level of responsibility. But to the average client looking for an enriching birth experience in a hospital, this scenario the nurses describe is their very definition of being frighteningly "swept away". So, if a doula can be trusted to provide that focused attention to non-clinical needs and let the nurses, doctors, and midwives do what they need to do to be the life preservers in this "surfing" scenario, we could have a really nice thing going on, giving birthing couples safe AND fulfilling care.

So, there are a few things I would like the general population of midwifery/medical professionals to know about my practice, perhaps dispelling a few myths and shedding light on some things you may not know about doulas (obviously I can't speak for all of us, but many would concur). The best way to do this is by exploring some of the assumptions I commonly see made about me and my work, which is probably reflective of what most doulas experience. Perhaps I can put some things into perspective.

1) Doulas are the ones who make birth plans for their clients.

The more experienced a doula is, the less I find she supports this whole birth plan writing phenomenon. Sure, we encourage clients to go over them to clarify their values by outlining options and hospital protocols, but we don`t normally have them bring a paper to the hospital. I don`t, anyway. I believe the term "birth plan" is pretty close to oxymoronic. If a woman is gung ho to write one out in detail despite my gentle explanations of how these take up staff time, which can sometimes make them a little on edge, it`s their business and I`ll support them. Staff members sometimes interpret a birth plan to mean the woman believes she will most certainly be the victim of all kinds of terrible things "done" to her if she doesn't write down all the specific things she will or will not tolerate, as well as demonstrate a belief that one actually has much control over a process one can never predict. I know this is not the intent of most women, and that they are very heartfelt and reasonable wishes. But the truth is, the vast majority of birth plans look exactly the same. Most people have the same statement, ``If my baby and I are fine, I would please like to avoid any unnecessary interventions, and I`d like to be able to move around as much as possible, etc. etc.`` They get very repetitive for everyone after a while, I realize. So PLEASE don't blame the doula for a long birth plan that ends up being a pain your butt. Essentially, if she does have a birth plan, I assure you it is not us pulling the strings and making her state these choices to play out our agendas...it is her own form of empowerment and it is her right to do so. There are HER choices, not ours.

2) Doulas are militant about natural birth, and discourage their clients from seeking out pain relief, even if they want it.

I have been in situations where a woman is working really hard to birth her baby without pain medication. This is what she has asked me to help her do, everything is going normally, AND she happens to be making quite a lot of noise in the process. I have had medical practitioners demand to know why I am holding my client to this choice, have had them get in my client's face while she`s contracting asking her, "is anyone telling you you shouldn't take the epidural, because I think you should," and insisting the woman needs an epidural because she is "out of control" despite the woman telling her she doesn't want one. Please do not demonize the doula for your patient processing her labour powerfully. This is just the way some women are, and their vocalizations, tears, and complaints in no way mean they are not doing a stellar job birthing. It just means this is how they release tension. The image of the perfectly relaxed, quiet, patterned breathing lady as the gold standard for "good" natural labour must be shattered. I have birthed all my children naturally, yelling the house or hospital down with each one, begging for someone to "get it out!" and have never regretted not taking medication. I didn't need to be saved, I just needed to fuss. Natural birth is not some uber feminist political activity. It is a process many women wish to embrace, and are interested in going through it the way Nature designed it, which happens to be a pretty intense design. Because she chooses natural birth doesn't mean she wishes she weren't in a hospital without her chosen safety net.. she simply prefers not to be part of the 98% epidurals for first time mothers statistic.

Disturbing her process because you assume it`s too hard for her doesn`t help her...it discourages and disempowers her. The only one holding her to task is her, even if we as doulas are actively encouraging her to keep on going. Trust that if she truly calls it quits, she will have our support...because we know her and this has been communicated between us before you`ve even met her, we are supporting her the way she`s asked us too. Sometimes you will see our support is to help our clients get epidurals as quickly as possible if this is their intention. Our clients vary a lot.

3) Because doulas don't attend as many deliveries as medical professionals, they cannot possibly have enough experience to offer.

Though it is true the volume of "deliveries" attended by medical and midwifery practitioners are and will always be far greater than those doulas can attend, you have to remember the HOURS we spend with each client create a lot of opportunity to properly witness and interpret, without clinical responsibility, the unique way in which birth unfolds for her. We have learned a lot about supporting birth, through experience you many not have, by witnessing birth at home, birthing centres AND hospital, often all the way from start to finish. I have insight into this process you may not because your time is divided and your observations are intermittent. You may have a 12 hour shift in which you visit periodically, whereas I am there the whole time, on occasion even for 48 hours in a row. I do the postpartum follow-up, and if I am blessed to attend the next births of these clients, I know them very very well. You need to trust that we KNOW our ladies. We know what they want, what they are afraid of, how they have been hurt in the past, we are keepers of some of their deeper secrets and quirks, know what words NOT to say, and have usually watched the way they labour at home before they get to the hospital. You might need to go out on a limb and have a little faith that even though you have more knowledge and experience regarding management of labour and delivery (and thanks for that..we are grateful you are there for the work we are not qualified to do), we may have a greater understanding of the flow of THIS labour and the personality/emotion/energy of the one who this labour force is being channeled by.

I have noticed a few nurses, when they find out I am a doula, get a little territorial and start wanting to "show" me their support skills (most don't...they just leave me do my thing and do their job), asking me why I`m not doing or not doing something they know to be labour support, assuming I`m bad at my job. And occasionally, in doing this, they provide support that is inappropriate to the client/patient we're tending to. For example, I have lots of women who tell me being too hot makes them nauseated, or that they hate being touched when they're in pain. From the many hours we have spent together prenatally, I know this. Seeing me NOT using heating pads or massage, or birthing balls, or directive breathing as labour support tools on occasion does not mean I am ignorant of them or too lazy to apply these techniques. It means I probably know this is something the client has intuited she won't want during labour. If a nurse walks in and starts telling my client ways to breathe or move or tools to use simply because it looks like I`m doing nothing, she may essentially be flooding the labouring woman with too much information in the moment, which draws her out of her deepest mammalian brain, and actually impedes the flow of labour hormones. Sometimes a doula's magic is about being still and quiet, simply being a resource a client can look at for a smile of reassurance or someone trusted and familiar she can reach out for when she needs. Essentially, we hold the space.

This does not mean I don't value a nurse's or doctor`s input! Ì am not saying they should leave all the support to us. I honour a nurse`s experience. If she says, "Hey, I have an idea!" or jumps in because she knows in any given situation a particular tool will almost always help given the huge amount of experience she has, I welcome this knowledge wholeheartedly, and thank those who are willing to help me learn. They are clearly coming from a place of good authority in this instance, not ego. I don`t hold the belief that medical people cannot offer fantastic labour support..they certainly can at times. I personally have been held in the arms of a family doctor while she slow danced with me in hard labour while I cried into her comforting shoulder about what a hard time I was having.

My clients have hired me as their constant and trusted support because they know it is intermittent at best at a hospital. It`s just the way the system is. Don`t take that personally. Knowing someone is there to make womens` labours more comfortable in the absence of a medical caregiver should make nurses, midwives, and doctors relieved, not wary.
4) Doulas tell their clients they can have a hospital birth without any interventions with their guidance.

Not true. We understand that by being in the hospital, we're in your house. I know your level of responsibility, I truly do, and I honour the work you do. If my client doesn't want to be monitored at all, I know this is unreasonable to expect. I will suggest monitoring in a comfortable position for her, or ask if monitoring can be more intermittent, but I won't lead my client to believe they can just easily go without monitoring or vaginal examination in the hospital. If my client decides to sign a waiver stating she is going against medical advice and refusing these things that are policy, PLEASE know I did not "put her up to it". It is often our clients who hire us because THEY are anti-hospital and feel they need someone to help make their experience palatable within that system. I actually try to help veer couples from this kind of thinking. I don't think it helps people to go into a hospital assuming they are going to be victimized. I don't want my clients to mistrust their doctors and nurses. I think this mistrust leads to a guarding of oneself that doesn't lend well to birth flowing smoothly. If a pregnant client doesn't get along with her caregiver, I suggest changing caregivers to one I can refer her to who I know is compassionate and respectful. If she is not willing to do that yet is willing to complain loudly about the disliked caregiver she refuses to leave, then I consider this a reflection of deeper seated issues I will be very aware of during the birth.

Our clients CHOOSE hospital birth, most often because this is what they want. To an extent, if they make this choice, they claim they are willing to jump through some of the required hoops and ride out some of the inconveniences as the price of the safety they feel they are buying from being in this system. To help them understand the reality of the system and what choices they may have to make in different situations is important, as sometimes in knowing, they are opened up to different realms of choice. But this is normally not done by doulas in a way that makes clients feel like they`re going on a suicide mission. Doctors and nurses should never be demonized, as these are the people who will be their caregivers. There has to be some trust in good intentions. In my experience, doctors and nurses are very much invested in their patients not only having a medically safe experience, but also a nice one. No good medical care provider is going to feel good about their patients feeling awful. When a woman has a birth she feels great about, everyone in the birthing room is really happy.

For a doula to lead her client to believe she will have a homebirth like experience in a hospital, especially by means of putting up a huge fight and mistrusting the establishment, is misleading and potentially wounding. We`re honest about the challenges, but we don`t tell them to approach medical personnel with viciousness. We are not about making enemies.

5) Doulas are totally against medical intervention in birth.

I have seen way too much for that to be true. I am not some wide eyed, naive, girl with flowers in her hair just because I work under the title of "doula" (which, but the way, I actually think is a silly name...not a fan of it, but it's so entrenched in the vernacular, what're ya gonna do?). I have seen fetal death a couple of times. I have seen ruptured uteruses. I have seen prolapsed cords and babies come out looking terrible without any apparent reasons. I`ve been at this for a long time, yet these instances are so rare, I easily manage to keep my belief that birth works great most of the time. I believe all interventions hold inherent value when used appropriately. And who am I to say whether or not the intervention is appropriate? If a woman chooses to birth in a hospital and agrees to follow her doctor`s advice, it`s not for me to assume she`s making misguided choices just because it`s something I may not choose myself. Just because a particular intervention may not be lavender scented or perfectly natural doesn`t mean the knowledge,technology, or medicine wasn`t whispered down by the same Source that motivates a favoured doula skill.

I'm not a medical person or a midwife, and I'm not out to endanger anybody by assuming I know much about clinical care. But I do believe in asking questions. If a resident comes into the room and tells my client that because she's been at 3cm (gently contracting) for a few hours and needs some Synto stimulation, I won't jump in and say, "No she doesn't!" and reach for my homeopathic remedies. That`s disempowering. After all, she may WANT the Pit. But I will ask my client how she feels about it, and suggest she ask if it's the resident's suggestion or if there is a real, immediate worry about the baby. I remind my clients who, like many people, are in awe of medical professionals and a little afraid to appear stupid by asking questions, that medical people are humans, and in my experience usually very willing to respectfully explain the suggestion/request/demand. The vast majority of doctors don't automatically assume they're being questioned or cornered because someone asks them a question. If a doctor says, "I'm worried about this and this and in my experience this and this can happen if we don't do this and this," this gives the woman information with which to choose. If I have questions of my own, I'll ask them, and if a midwife or medical person takes the questions personally, that is a reflection of them, not of me. My respectfully put questions are intended to gather information and learn, not a knee jerk reaction to criticise or negate a clinical call.

Now, I have had some pretty intense encounters with doctors. Some hate doulas on sight, and will take our presence in their house very personally. I had a doctor who seemed to think I was "protecting" my client from their ``evil ``vaginal examination because I held her hand and guided her to breathe in and out gently before their fingers were introduced. They said, "You act like you're preparing her for the worst." and I could just hear the anti-doula alarms ringing. I was actually preparing her not because I thought they or their exams were evil, but because she had told me in our prenatal encounters that her cervix was very tender and has always experienced terrible pain with examinations. After that, things just went downhill. Because this lady was standing up a lot and was receiving intermittent monitoring at her request, the doctor was sending out the vibe they thought these clients were anti-hospital birth and were using me as a resource to tell them what to do. The doctor started making comments to them like, "You know, in obstetrics it's not about what YOU want." These clients were not children who needed lecturing and of the mindset that birth should be natural at all costs! They were not asking questions because they were anti-doctor, yet they were being treated as if this were the case, and the level of tension in the room was terrible. Sadly, she never dilated beyond that point, and could just not get her mojo back. What makes me sad is that I've had great births with this doctor in the past. What I'm thinking is that this person may have witnessed some pretty bad doula behaviour for them to formulate such a strong reaction over a slight that didn't even exist. For that, I feel sorry, as if I need to apologize for all those of my kind who step on toes and enter the hospital with a bad attitude. At some point, I hope this doctor learns to trust me, knowing if my clients are not on IV or monitor all the time or ask questions, that it's emphatically not because I set out to sabotage their approach to care. I am not so powerful that I can pull those kinds of puppet strings, even if I wanted to.

I will be the first to congratulate a client for choosing an epidural if she felt she was suffering with her labour for whatever reason and was no longer open to my suggestions, or jump in with getting her on her back with directed pushing if that's what she says she wants or proves useful to her. If a client is vomiting and clearly becoming dehydrated and nothing we try alleviates this, if a medical person starts talking about IV, I gently validate the value of IV hydration in cases like hers, even though she may have been desperate to avoid that intervention. It's not that I am trying to get her to choose that, but to perhaps buffer some fear around it. If a mom is going to choose in intervention, the last thing I want is for her to be in mortal fear of it. It won't work as well. As a doula, I have to give both sides of the story without bias. This way a woman can truly choose as opposed to being led somewhere according to my personal bias. And remember, I am dealing with women here who are choosing to birth in a hospital, meaning they DO have an underlying fear a lot of the time of all hell breaking loose in labour. They are there because they want options and feel safer knowing there are shiny machines that go "ping". Homebirth is a whole different kettle fish, and the beliefs about birth for women who choose this setting are not generally coming from the same gestalt.

6) Doulas believe that if a client is informed and does everything "right", she will be rewarded by a wonderful birth.

Just because we are helping a client who wishes to minimize interventions where possible, does not mean we are subject to magical thinking. Please give us more credit than that. The one thing I emphasize to my clients is that birth is unpredictable. I encourage flexibility. I help them to be able to ride waves of any nature, not just the lovely natural birth ones. I don't see a C-section or epidural as some kind of personal failure. It would be terribly cruel to project that kind of perfectionism onto any mother. In fact, I find the couples who are the most easy going, the ones who are committed to natural birth but are open to intervention if necessary or if it becomes a personal choice, tend to have much better overall birth experiences....far better than those who write super detailed birth plans. It's the people who are totally attached to natural birth no matter what, who assume they will feel like failures if things don't go the way they want, and who are judgmental of those who are too "unaware" to eschew these interventions, who often end up being quite disappointed in their experience. I don't mean to get esoteric here, but it seems the more you try to hold onto control during labour, the more it tends to veer away from you. The Great Lady Birth doesn`t like to have assumptions made about her. It's great to hold a hope and an intention, and I fully support someone sayìng, I`m going to go all the way for a natural birth!``, but I do feel having the flexibility to move to Plan B is a great resource.

This is not to say that flexible people do not get wounded in birth...a bad environment, unanswered questions, lack of respect and compassion, and lack of knowledge of options can definitely create birth trauma, as can just a really rough natural birth. This is where doulas come in...to help that kind of trauma not happen. An unexpected C-section is usually a lot easier to heal from if there was respect, information, and loving words. At least a woman is not left all alone in the dark thinking, "my body must be defunct." This is a hard wound for a woman to bear. As doulas we have tremendous power to connect a woman to those areas of her birth she shone and was really strong and amazing, even if things went unexpectly. We believe happy mothers who feel great about themselves provide calmer, happier care to their babies, so their feeling as good about themselves even in light of a harsh experience is crucial to healing.

What I can tell you, is that I believe most of the time birth works really really well, and while I as a doula cannot recreate Ina May`s Farm, with a combination of good clinical care (midwifery/medical) and good supportive care (doulas), we provide what parents feel is the best of both worlds. In doing so together, we CAN reduce the rate of unnecessary interventions, have the world populated by happier, more emotionally connected parents, and have healthier, happier, more emotionally connected babies. It's not a bad goal.

Doula work is mostly joyful, and most doctors and nurses I know like their jobs a lot too. If this were a profession that caused constant trauma and heartache, I personally wouldn't do it. To witness the birth of a child into the arms of an ecstatic mother and father or non birthing mom is one of the most enriching things I can imagine....and I get to see it much of the time, even, yes, in hospital birth where most of my clients choose to have their babies.

I hope I have shed light on some of the ideas people have about doulas, as well as explain some of the challenges we have given common attitudes about us and our work. I know this list is not complete, but I hope it gets some good dialogue happening.


Thursday, March 4, 2010

Doulas Behaving Badly

My daughter Kayleigh came home a couple of days ago from her gym intensive class with some interesting information. She had been distance walking with a girl in her class who is a nursing student. It turns out she works in the Labour and Delivery unit at a hospital I practically live at. When my daughter told me her name, I was familiar with it. A nice girl, who always greets me with great friendliness. I enjoy working with her. So it was with mixed feelings when I heard from Kayleigh that this nursing student generally doesn't like doulas. Kayleigh informed this young woman that her mom was a doula and mentioned my name, and this is when she said, "Oh, Lesley is one of the few doulas I really like. But most of them I don't like. They take my patients off the monitors and mess with IVs."

What I want to know is WHO of you doulas out there are doing this?! Because you know what? You've gotta stop. I don't know about you, but I have worked long and hard to get in a position where doctors and nurses trust me. In fact, most of my business is through doctor referral. It is this trust that has led to my good success as a doula. I did not sign on to be a doula who works mainly in hospitals because I am personally a big fan of hospital births in general. I'm an avid home birther. But my purpose and my goal is to ensure women get the best possible care within the system they choose. This is not by control, but by support. I truly feel if all members of the team took time to look into each others' hearts, we would most likely find the same intention...to hold a space, the way we know best, for a safe and happy outcome for the mother, father, and baby. We may have different approaches to this goal, but each member has a valuable role that deserves respect.

I personally think it is extremely bad behaviour on a doula's part to fiddle with equipment in a hospital because you are trying to reduce intervention. This is not advocacy! This is blatant rule breaking, and creates the risk of getting us banned from hospitals altogether. In fact, one of my clients told me that at one of the hospitals I work at less frequently, there is a group of family doctors who refuses to work with patients who have doulas. This breaks my heart, because I know if they could only witness a few good experiences with doulas, they would relax, and see the value of our services for their patients. My best experiences are usually ones in which family doctors are involved, and I think these doctors who have banned doulas are denied of seeing the kinds of births that are common with the presence of a good doula. It only takes a couple of bad egg experiences to put people off eggs.

Why should you not take women off the monitors? After all, they're on there way too long a lot of the time. Because, it is not your role. You can track down the nurse and ask her to please take off the fetal monitor, explaining your client has been on it for the required time. In my experience, once I ask permission, I see the beginnings of trust start to happen. The nurses know I am not out to sabotage their work. Imagine being them for a minute. They are responsible for the monitoring of their patients. It is they who usually decide whether or not a doctor needs to come into the room to check things out based on what's going on with the mother and baby. If a nurse is required to have a mother on the monitor because that is the rule of the hospital, she comes back in and you've undone the whole thing, something happens with the baby, who do you think gets in the most trouble? Probably the nurse.

I'm a pretty experienced doula, and am capable of reading a monitor, getting a general sense of how things are with the baby. But I am not qualified to diagnose this for certain. There are probably a lot of things I DON'T know about reading a fetal monitor, and I'm not going to assume anything. If your client wants to take off her monitor, it is her right to do so whenever she wishes. But not at your request or suggestion. And it is certainly not your right to take her off the monitor for her unless there has been an agreement between you, the client, and the nurse. Ask the nurse. If she doesn't agree for some reason neither you nor your client understand, ask the head nurse. In my experience, when a nurse sees I am playing by the hospital rules, she often gives me permission saying, "okay, take it off, but just buzz me and let me know so I can mark it down." Building this rapport of trust is essential for us to continue our work, so we can demonstrate the kind of birth outcomes that make doctors and nurses stand up and take notice of how important our work is.

Combative doula behaviour is not going to change how the hospital operates. If you go up to a nurse, get in her face, and say, "What do you think you're doing?" every time she has to turn up the Synto (because it's her job), you are not going to teach that nurse a lesson in Synto administration. It's going to make her say, "Screw you and the little weekend workshop you came in on." At the nursing station, they will laugh at you for having the audacity to assume you know the "right" way for them to conduct themselves. Now, perhaps you do. Perhaps you are savvy of evidence based medicine based upon things they have not studied. No matter. Your behaving this way will not ever get your thoughts listened to. No change will be created. In fact, you set it up so there will be a very shaky future for you and your doula sisters to work within.

The environment I work in is accepting and allowing of my doula care, through familiarity, careful diplomacy, and trust. If I were uncomfortable with a way a nurse was administering Synto, I would suggest the mother or her partner to ask, "I really am having stronger contractions now, would it be possible to wait a little before upping the Synto?" (in the hopes that the mother's body will take over, negating the need for more). Most nurses say, "Sure, we can wait a bit if that's what she wants." If they are really adamant about not allowing this and you're not sure whey, you could talk to the resident or doctor, though not in a way to make it seem like you're "telling" on the nurse. They may give you a very valid reason you didn't know about or consider. If everyone says, "no," and you don't get it, the client herself or her partner can certainly speak for themselves. They're not victims here. It is ultimately their battle, not yours. And if they decide to accept this treatment, even if you think it is inappropriate, what do you do? Suck it up. It's not your choice. Yes, it's hard to see things administered when you are very aware of the risks and see them unfolding before your very eyes. But you have to remember: your clients CHOSE hospital birth. By going into this environment they are aware that for the sense of personal safety they're buying by being there, there are some challenges associated with that. Don't assume that because they acquiesce to a procedure you don't like means they feel victimized. Don't assume, "oh, if they had all the information, they wouldn't make this choice." Not true. Your clients are not representatives of your own personal agenda to educate staff members on what you feel is the "stupidity" of their protocols.

You may ask, "what if my client doesn't have the type of personality where they can stand up for themselves?" If you inform them to the best of their ability, giving both sides of the coin, your client can tell you what she wants when you have a private moment, and you can communicate it, letting the staff know you are stating your client's wishes, not yours. I'm not personally a fan of doing this, as I think even if women can't speak because of the labour, their partners can. But sometimes you're with a very vulnerable woman who is alone, and you make exceptions. If, however, she can't stand up for herself even with your help because she's afraid of creating conflict, making choices based on not rocking the boat instead of on what she needs, you have to wonder at what point you are at the line between empowering and enabling. Where does your role of advocacy end and your journey of owning the birth for your client begin? Stand back and re-examine your intention.

If you can't stand the heat, get out of the kitchen. If you loathe attending hospital births, stop. If you cannot abide the procedures and the way women are sometimes treated there, fair enough. Not everyone can stomach it. If you feel like you have to weep every time a woman gets an unwarranted vaginal exam, even if she doesn't seem to mind, you are in the wrong profession. Maybe midwifery is more your calling, so you can provide consistently compassionate clinical care. You know what? I don't like MOST of the ways birth is dealt with in the hospital. And that is precisely WHY I'm there. I know, through experience, that gently and lovingly going about my work, being present for each experience, finding the best in people, making friends, respecting ideas, and working together is how the change is made. I have to digest an awful lot of crap and witness some yucky things in order to do so, but I can tell you it is working. The head of OB at one of the hospitals my colleague Rivka and I work was at a meeting some nurses and doctors had invited us to. She acknowledged and honoured our work there, recognizing the importance of our statistics, and is interested in using us as resources to help lower the rate of some of the interventions. The doctors and nurses had to qualify, "Lesley and Rivka are GOOD doulas," implying there are problems with doulas out there who are on political rampages, in violation of active but non-violent communication.

Doulas, you have TREMENDOUS power to bridge the gap between holistic and medical maternity care. We can help warm up a frosty nurse with friendliness. We can have our clients ask questions about their care which lead to their choices being honoured. We can encourage and praise a new doctor for catching a baby in an "alternative" position so he feels more confident about it for the next lady who comes along. We can show them that most women can give birth without pain management if they choose and circumstances favour this choice (if you set up a lot of tension and conflict, this will be less likely...it may not after all be the "system" to be "blamed" for the woman's epidural..it might be you). I have had lots of doctors and nurses ask me about the non-pharmaceutical ways I help to ease back pain in labour. They are interested. We can buffer the environment, and support our client strongly when things go out of every one's control. These are small but powerful ways we work, creating momentum. But we need a mellow environment for that work to grow.

Simply put, women are not all gonna be running off and having home births just because we embrace it to be a safe, wonderful option for most families. The vast majority of births are going to be in a hospital, like it or not. Is our mission to be "right" and go about snottily proving it to every nurse who ups Synto through an IV, or is it to lovingly welcome in a baby to a mother who feels as empowered, respected, and loved as we could make her feel? If she has a crappy birth experience in spite of all your good work because the people at the hospital were nasty that day, well, that might make her choose a different option the next time. And if she has a wonderful experience, is this not MARVELLOUS enough?

So, all you doulas behaving badly out there, please understand you are hurting the cause. You may justify yourselves all you want by making snide remarks about brown nose diplomacy. I would rather wipe off the occasional stain than have my spotless snout shut out entirely and responsible for leaving vulnerable women unbuffered in that system. Because that is effectively what you are doing. Instead of healing this birth culture through your angry, righteous approach, you are going to get doulas, the very ones who hold the power to heal it, barred from hospitals entirely. When that happens, those hospital birthing women will not have access to the care they need from us, thus limiting their choices and potential for amazing experiences within that harsh environment even further.

A woman's birth is her own journey. It unfolds for her, provides lessons, transforms her, and gives her a baby. There is not a lot of control over that. Sometimes you have to sit back and watch things you don't agree with go on. Midwives and doctors do this too. If you think a birth full of interventions is necessarily a reflection of how good or bad you are as a doula, and this is one of the reasons you are so viciously opposing them, you are working from your Ego. Let it go, Sister, and focus on the bigger picture. We need you.


Wednesday, March 3, 2010


It is a beautiful day today! So many options! In fact, so many, I'm feeling overwhelmed. When there is too much to do and no concrete plan, I tend to get very unfocused and end up frittering away my time on things of not so much importance.

My friend Millie, who is a postpartum doula of remarkable talent, believes the 24 hour day was invented by someone who was most definitely NOT a mom.

My kids are on Spring Break, so I am not doing any pre-post natals, though I will be having a birth within the next 48 hours almost definitely...maybe even two. Even so, I feel busier than ever.

I have childbirth videos to wade through in order to show my Birth Essentials prenatal class attendees different views of labour. I have content to organize. I have SO much administrative stuff I am backed up on. I promised to take my kids to a movie. I have yoga to do, a carrot/ginger/ cashew soup to make, more Doula Training applications to look through (we're at about 10 students now, and still 5 months before we start), I have writing deadlines, piles of laundry, plus the daily answering of calls from potential clients and communication with clients with questions and concerns which punctuate my day. The dog needs all kinds of ear treatments which take time to do. Pots and pans to scrub. All you moms out there know what I mean. Whether or not you have a "job", the business never ends.

I long for a couple of days to do nothing. Or a week without work or cleaning to organize my files. I feel like I'll never get on top of it. My issue is my distractibility. I am a hyper focuser by nature. If I am deeply absorbed in something, I will forgo food, people will literally have to yell at me for my attention, and find it extremely difficult to pull myself away. It is almost impossible for me to get back to that task once the concentration is broken. And of course, with four children, there are distractions at least every 2 minutes, plus the phone calls. Ah, well, one step at a time. What I love about being at births is that all these worries fade and all I have to do is be blessedly in the moment.

Off to find some focus. Have a wonderful day!

Monday, March 1, 2010

Spring Break

My younger kids have Spring Break this week. It is SO nice to take a break from the daily grind of getting up early, before school/work chaos, the day running around to pre/post natals, home, dinner, then administrative work and family time. I enjoy sitting around in my jammies for the morning and being leisurely, eating decadent things for breakfast and enjoying a slow cup of coffee.

I am happily expecting a couple of births this week. I haven't had a birth in 2 weeks, and this is a really long time for me to go without attending one. I'm excited to reconnect to that energy again. After my last child was born, I took a few months off from going to births, and I would find myself calling my colleagues and students every couple of days to hear new birth stories. It just never gets old.

I think about what I'll do someday when or if I retire from going to births. Probably teach and write about birth full time, most likely. And travel the world. I had my first children quite young, and continued having a baby here and there until I was 35, so a lot of travel has not been so feasible. Until then, though, there are still so so many things to do. I would love to do a shamanic herbalist apprenticeship with Susun Weed. I want to study osteopathy. I want to do more in depth midwifery studies. It's not that I want to practice as a midwife. Not at all. But I appreciate learning as much about something I'm dedicated to as possible.

I may be going away a bit this September and get the opportunity to learn some more technical midwifery skills, though that's not the intent of the trip. I'll keep you posted on this as the plans shape up.

What I have really enjoyed about knowing about the midwifery approach to maternity care, being a consumer and a witness, is talking about it with the friendly doctors I work with. When they're open to it, they're quite fascinated. On occasion I will be with a nervous resident and a woman will be insisting on staying in her hand-and-knees position to birth her babe, and I've been able to talk the resident through it to some extent if they've open to hearing it, giving them little tips on how I've seem midwives do it. or at least reassure them the baby can certainly come out this way, as I've seen it many many times and know it's possible, having birthed in that position myself, as a matter of fact. It's a very interesting part of my job, to evoke interest in what those crazy midwives are doing in out-of-hospital births. I so wish the system was such that midwives could do some skill enrichment workshops with doctors so all the docs could catch babies in different positions with confidence. This would create so much more opportunity for women to have better births in the hospital. But alas, I can't see this happening for a long time, given the general feelings of animosity between doctors and midwives here.

As a doula, I seem to be in a unique position. Most of the doctors I work with trust me and know I'm not out to practice midwifery "on" their patients. My clients are all very aware of who their primary caregivers are, and know I don't take responsibility for monitoring their babies or checking their cervices at home. So the doctors know I know who calls the clinical shots. This clear boundary seems to be one of the keys to that trust. I don't remove monitors without permission or fiddle with IVs or try to catch a baby before the doctor gets there, as I know some doulas have the reputation of doing. They also see the results of their patients having doula care, and most are now definite supporters of doula attended births. In fact, my doula colleague Rivka and I have been approached on occasion by family doctors and nurses to potentially do some doula training for medical/nursing students. We did a workshop once with family doctors on non-pharmaceutical pain relief in labour. Now THAT was exciting, as we generated some inspiration. Though I'm not a midwife, I am a natural birth ambassador within a high-tech system, witnessing births from every point in the spectrum, and it is a powerful position to be in, as I can do some serious seed planting in the hopes of creating a little more gentleness within this system.

In any case, I feel a more in-depth blog steeping on that subject, but I'll leave it for now, and go enjoy my kids, who seem to be in a pile, wrestling on the floor with the dog and their dad. I'm jumping in!