Saturday, December 31, 2011

2011 Births: A Doula's Year in Review

I seriously doubt a new baby will eke its way into the world out of one of my clients within the next few hours (though anything is possible), so I thought I'd look through my birth notes of this year to see what's cooking in terms of the efficacy of the work of doulas.

This year I attended quite a few births less than I do on average. The grand total was 37 births. My goal was to cut it down to 30, but it's SO hard for me to say "no" to my repeat clients. I took off most of April, all of July, half of October, and only took on one birth for December. So given I was actually off call for a good 10 weeks to teach or go on vacation, it still was a decent amount of births.

I had a higher than usual amount of "out of hospital" births with midwives (six). Out of the nine planned, two transferred to the hospital in late labour for medical intervention (one a first time mom, and one a second, both for vacuum extraction after prolonged second stage), and one was risked out of her desired midwife attended birth and medically induced because of pre-eclampsia (all gave birth without epidural).

Four of my clients gave birth by Cesarean. One was planned due to a breech baby and large uterine fibroids. One was an emergency with the baby during second stage (all worked out fine in the end). One was a mom who had wanted a VBAC, but developed an infection just prior to labour, and another was a long Cervidil/Synto induction for post dates which ended up simply not progressing after a very long and heroic attempt. All moms and babies are doing just great.

Nine of my total number of 37 clients received epidurals, for all reasons ranging from personal preference (yes, doulas DO take clients who know from the get go they WILL take an epidural no matter what...we are all for informed choice) to very long, difficult labours in which the choice to take an epidural greatly helped the mom's experience.

11 of the ladies who did not receive epidurals were first time birthers, and three out of these were medically induced (one with Cervidil, which produced a baby super fast, and 2 with Synto). One induced with castor oil at 2 weeks post dates. (Nine of these un-epiduraled births took place in a hospital setting ).

13 of the ladies who birthed without epidural were having second or third babies. One was induced simply by having her waters broken.

Out of the ladies who did receive an epidural, (one first time and one second time birther), two were long, exhausting inductions.

Two of the 37 births were VBACs (which is a low amount for my usual total). A third was an attempted VBAC, but the mom birthed by Cesarean again.

So in terms of percentages:

Cesareans: 10.8% This is less than half of our provincial average.

Epidurals: 24% In Montreal, overall epidural use is about 80% (this is not including my mothers who had Cesareans...they only took epidurals very close to their surgeries.

Because "natural" birth can mean many things, to clarify, because I work with a mainly hospital birth population, I call a "natural" birth one in which there was no epidural or Cesarean. This can include induction, episiotomy, vacuum extraction, whatever. Yes, I know, purists would take great issue with this, but if a woman is able to go into a hospital and have an induction and perhaps vaccuum extraction and can pull this off without an epidural, darn right we'll let her claim natural birth. What are you gonna say to a lady who has a 48 hour labour and ends up with a vacuum extraction as her only intervention? Sorry, Dude, no natural birth for you? Nope. Everything is relative. I hesitate to use the term "normal" birth for all these births, though, as most births I see in hospital settings are not normal by virtue of the hoops women are asked to jump through even when they might not want to, hoops that can be antithetical to the physiological process of birth (lying on back, being tethered to an external fetal monitor, being engaged intellectually during contractions, directed during pushing, her environment outside of her control, etc.) But this does not mean women don't have GREAT births in the hospital much of the time and are very happy with their experience, even if they were not "normal" or "natural". So, yeah, I say natural when there's no epidural. Period.

And the rate of moms having a natural birth:

The most hands off birth I saw this year, meaning the baby was literally only caught once in mid-air because she insisted upon not being touched, the room was nearly silent, the mom was left to pick up her own baby instead of her thrown into her arms (the mom was on her hands and knees and the baby was scootched between her legs up to where mom could look at and take her when she was ready), the cord was left for a good 15 minutes, no perineal checks, "massage" of the uterus, or management (besides quiet, respectful vigilance)until after the placenta was born, and no routine Synto, was not where you would expect. This birth took place in a hospital with a nurse and an obstetrician who were both SO happy to serve the woman in this way. I wanted to weep with the hope of possibility.

My stats also consistently illustrate that epidurals don't necessarily always go hand in hand with inductions, depending on the type of induction.

While many of my clients came to me wanting a natural birth, many of those who were not sure what they would choose in the moment DID end up having a natural birth. And several who KNEW they wanted a natural birth, did NOT have one for varying reasons.

The shortest labours this year were about 1.5 hours from the time contractions were noticeable. (one was a first time mom)

The longest was about 50 hours (first time mom), about 36 of those hours having contractions strong enough to make her vocalize.

The biggest baby was 10.5 pounds, born at the Maison de Naissance to a first time mom in about four or five hours of labour with a WONDERFUL, skilled midwife who knew to keep the oxytocin flowing by keeping Mom calm and focused when the shoulders proved to be quite jammed. She never screamed (PUSH, THIS IS SERIOUS!), because fear and arenaline tend to have the opposite effect on what needs to be done by the mom. It was a brilliant and enlightened approach.

Thank you, all my wonderful clients and babies, for allowing me the honour of attending your births! You are all rock stars of the highest degree. And thanks to all the caregivers who did great jobs in keeping the birthings safe and the environment pleasant. Blessings to all for a wonderful New Year!

Tuesday, December 13, 2011

Between Fear and Dreams: Birth Wants her Soul Back

I was recently sent a beautiful video of how nurses process their own grief when they've supported families through perinatal loss. The quality of a medical caregiver's presence can be pivotal in helping families who are dealing with grief, and my hats off to those who, with exquisite sensitivity and compassion, make a seemingly impossible path just a little smoother and more light filled. While for the most part the video was a guide to how nurses can move through their own emotions surrounding difficult experiences, it brought up important observations for me. They came up when one of the nurses was discussing her own personal experience of pregnancy from the perspective of one who sees stillbirth and tragedy on a pretty regular basis. She describes being a student in her childbirth education class, and how couples would discuss things they wanted for their birth experience. This nurse admits, "I don't care about episiotomies or anything. I just want to be alive, and my baby to be alive."

My heart just broke for this nurse. I witnessed someone so steeped in the experience of being a relatively frequent witness to tragedy that she dared not invest her heart in any desires towards her own birth process. It was almost as if wanting more than simple life was an audacity. I have seen this with clients who have experienced previous perinatal loss and are expecting a subsequent baby. Where once they were innocent, concerned with cloth vs disposable diapers or about the risks of epidural, or prefering to refuse a routine IV during labour, their innocence is shattered by grief and the fact that life can seem cruel. Once bitten, twice shy.

Herein lies a very important issue at the heart of some of the problems we face as consumers of medical maternity care: our doctors and nurses, given the high volume of births they see ranging from the mundane to the highest risk possible, fairly frequently witness death as a result of pregnancy and birth. It's clearly not something they can avoid, as this is the occupation they signed up for. Remember, this exposure doesn't mean there IS generally a lot of death as a result of birth if you look at overall outcomes. The exposure comes comes from witnessing high volumes...hundreds of births per year, many of them, depending upon the hospital centre, extremely high risk. As they say in the labour and delivery wards, most of the births are regular to the point of boring. It's the small percentage of drama that keeps everyone on high alert. It is all part of the job of being one who assists women on this journey to motherhood. But if the experiences of trauma and loss go improperly processed, there are aspects of this frequent exposure to heartache that have can have a negative impact upon us as birthing women.

To see death in the labour and delivery ward is not the same as being in geriatrics or ICU, as many patients in those wards are expected to pass because they are old and/or sick. But when a couple is expecting a happy start to family life and that dream is tragically extinguished, not only do caregivers mourn the death of a sweet, innocent baby, but bear the burden of parents' acute shock and grief. To witness a mother holding her lifeless baby, those months of hopes and dreams just gone, or to see a father simply shut down, his shock rendering him broken spirited, is emotional suffering I cannot even describe to you if you haven't seen it yourself.

We are blessed in developed nations to have access to these caregivers who can save us and our babies when emergencies occur, we truly are. More tragedies than we could imagine are prevented with this incredibly skilled care. But sometimes Nature overrules and no matter what is done, no matter how many years of studying someone has undergone in surgery and pathology, no matter how much experience they have, no matter how careful they were, no matter how safe the situation might have appeared minutes before all hell broke loose, someone dies. Sometimes it can't even be identified why. And in our culture, this is perceived unacceptable.

In order to truly understand where medical caregivers are coming from, and to glean an essential insight into one of the reasons why our birth culture may appear as wounded as it is, it's important to look at a few thing. Take the personal grief the caregivers most likely feel in reaction to their experiences of tragedy into account (nobody goes looking for that feeling, and in fact tries to avoid it all cost). Mix it up with the weight of responsibility doctors and nurses carry for us (we go to THEM for care, expecting THEY will keep US safe). Now throw in the fact that in the midst of overwhelming grief, sometime parents might feel they need someone to blame (which will usually be the caregiver who, being the responsible expert we entrusted our lives to, "should" have been able to do SOMETHING, or something different from what was done, to avoid the devastation they are now suffering). This cocktail of pressure can potentially create a powerful fear of future emergencies, disasters waiting to happen, and ultimately, the unpredictable mysterious nature of uncontrolled, unfettered physiological birth...which, on occasion, leads to grief. And it is this fear which surrounds and permeates the hallways of the hospitals these medical professionals practice in, as well as the rooms in which many of us attempt to birth normally.

In some schools of psychological theory, it's believed that when we experience a trauma, there is a disassociation of a portion of our presence from the experience. It is a protective function of our minds, serving to spare the psyche from unmanageable pain during a time attention is needed for survival. But at some point, that trauma and the emotions involved (that were neatly tucked away to help us function in the world) need to be revisited and processed in order for us to heal and move on, to re-associate essentially. Shamans of old believed that a piece of one's soul actually fractured away during trauma, and got left behind in that traumatic experience, existing in a different dimension indefinitely, longing to come home. One of the ways they would seek to heal their tribes people would be to conduct a ritual of soul retrieval. The shaman would go into a state of trance, and supposedly travel in different worlds of non ordinary reality to seek those pieces of soul, bring them back to his patient, helping to reintegrate the lost piece so it felt welcome. The patient would experience a cathartic release of the emotional energy caught up in the lost piece, and then they would live a more whole and balanced life with that blessed reclamation, being able to maintain a normal instead of wounded perspective of the world.

If a person does not eventually process the disassociation that served at the time of the trauma, a person can be easily triggered into post traumatic-like reactions in situations that resemble the original trauma. Even the thought of a repeat of the traumatic occurrence can trigger rushes of adrenaline and fear. This is a very painful way to live, as access to many of one's internal resources are limited.

All this is to say, I believe our birth culture functions around massive chunks of missing soul pieces, if you will. I make no personal accusations here, as many of the caregivers I know and love are very well integrated and can weather the occasional loss of life inevitable in childbearing without becoming traumatized. But I believe collectively, Medicine just may be learning, working, treating, and intervening from a place of post traumatic stress. And no wonder! Imagine this (and I am not making up this scenario): you're a nurse, and you've just helped with the delivery of a stillborn baby who died right at that 41 week and three day line, the non-stress test you set her up for and ultrasound having seemed perfect the day before. You're still wiping tears away after having wrapped up the little body for the parents to hold, inside wondering if you could have had any power to change this outcome if you had just a little more forcefully encouraged the mom to induce a few days earlier when you put her on the monitor. Part of you is worrying about how the parents might react if they somehow wonder the same thing, and this will haunt you for a long time. Then suddenly there are premature twins down the hall who need delivering fast to a pre-eclamptic mom and all hands are needed on deck! On the way to that family in crisis, you run into a patient you know from care you've given her prenatally in the hospital, who is just admitted in labour. She is wanting to birth naturally and has this list of mundane f$#*&#g requests she's flapping in your face, requests you've heard a million times from a million people! You are holding so much in your heart and mind right now and this woman wants things that you might, with the perspective you've gained from your job, have discovered are luxuries and trivialities apart from a living baby.

I stop here to take a deep, long, breath of understanding, of compassion, and of true honour for all you are capable of and willing to do to keep us and our babies alive. I invite everyone here to do the same..take a second to breathe and put yourself in that place. Empathy is crucial to truly understanding, gratitude amplifies our loving energy far more than angry blame, and this opens our hearts to the beginnings of healing. Let us start by seeing the big picture behind what we perceive as the fear based medical practice that we feel puts our birth experiences at risk.

The average person who is effectively attempting to retrieve missing soul pieces can usually get away from their triggers to gain perspective. The woman who is constantly traumatized by an abusive partner can generally begin to heal when he is out of the picture. It takes a lot of psychological work for her to come to a place where she doesn't perhaps perceive all other men as threats or go into shock when she sees someone wearing something he used to wear, but with support it can be done. A recovering addict must remove himself from people, places, and things for a while that he associated with using his drug of choice in order to heal. While still raw and processing his emotional pain, the associations with the drug of choice can be a powerful trigger back into addictive behaviour.

So what about the medical care giver who, after having experienced the trauma of a baby dying on their watch, has to go back into the trenches and keep going, knowing they will inevitably see tragedy again at any random time? Well, chances are they're going to up their game in the vigilance department. And given that they're pretty vigilant to begin with, this is saying a lot. If they've seen uterine rupture during an attempted VBAC, VBACs may be something they're deeply reluctant to do in the future, for a while anyway, until the event is sufficiently behind them and they feel open to trying again. If they tried a breech birth and the baby died, chances are, they're going to be unwilling to revisit that scenario again any time soon and prefer to perform Cesareans on their patients with breech babies. Because of a seemingly large infant, many caregivers will not be willing to allow a vaginal birth given the higher risk of shoulder dystocia and the devastation that can potentially entail. Why? Because they've seen it! It's normal human behaviour. If your house gets broken into, you'll probably get a better lock or alarm system and never leave that one window open again at night, regardless of the lovely breeze that used to come through. If you've been mugged, you're going to be on higher alert when you're walking down the street alone at night, or skip that route altogether, even though you may have walked it happily and safely every night for ten years. It is human to try to avoid pain and recurrence of trauma, and a health care provider is psychologically no different. In fact, it's deeper than that, as they are not trying to spare their feelings necessarily, but someone else's. They are also at the mercy of many rules, no matter what their personal beliefs, rules created by that collective deep seated fear of unpredictable old birth and death.

The build up of post traumatic stress in Medicine doesn't help birthing families in many aspects. One could argue that aggressively applied obstetric care has reduced death all around, and sure, there are truths to that, such as the fact that experience gained in dealing with trauma provides practice with how to work with complications more effectively. I'd sure like the guy dealing with my stuck baby to have oodles of experience in doing so. But consider how fear-based care may not be so great for us. For example, in North America the Cesarean rate has risen crazily in the last decade or so, while outcomes have not really changed in response to this impetus to get babies out surgically. This is testament to the fact that women and babies aren't actually generating any more emergencies than before, but that Medicine is scared. Scared of messing up, scared of allowing the unknown to emerge, and scared of not pulling out all the stops to get a baby out in decent shape. Women are scared too, as seen in some North American hospitals where more Cesareans are planned and preferred over vaginal birth. As a result of fear begetting fear begetting fear begetting even more fear, we have become a bundle of simmering panic threatening to erupt.

The belief of health care providers and many parents that technology and medications are always being logically and judiciously applied, or the fact that arcane practices are being imposed upon birthing women routinely regardless of their good health or what they may want, (lithotomy, continual fetal monitoring, etc) illustrates that we as a culture are servants of Terror when it comes to normal birth. We say it's all about safety for Mom and Baby, that the hyper-vigilant, agressive "just in case" approach is for the best. But our North American statistics don't always prove the safety of our methods of trauma prevention the way we may hope. Yes, overall we do a great job! But we can do better. When we compare our maternal/newborn outcome statistics with those of some other developed nations in which there is generally a lot less fear surrounding the birth process, a different story emerges. In these countries, trained, skilled midwives are attending the majority of normal births in birthing centres or at home, and obstetricians are usually reserved for complicated pregnancies and births. We see that they are enjoying better and happier outcomes. Our fear centred, overly managed practices are not serving mothers and babies as well as the mother/baby/wholistically centred practices they have in Holland and Norway. A mother's positive experience of birth and postpartum is very important to these cultures. In Holland, a woman whose role is similar to that of a postpartum doula comes to the mom's house daily to tend to her for weeks after she's given birth. And this is at no cost to the family, the government pays for it. Our focus is single minded in that a live baby/live mother is all that's really important; well-being is simply icing on the cake, which is an attitude very harmful to women in general.

I in no way want it to be thought that I don't believe we should have OBs deal with normal births anymore. I will address this more in Part 2, but I want it out there for the record.

Normal, physiological birth has come to be considered a radical act in many circles. Many caregivers AND many women HOLD NORMAL BIRTH IN CONTEMPT, even though many have never even seen what that looks like. The fact that birth is SO out of balance, meaning that regular old labour and birth is rarely seen in modern hospitals, reflects a physical manifestation of massive collective terror. Aspects of that are profoundly unhealthy to women, their partners, and babies; physically, emotionally, and spiritually. Surrounding this truth are some groups of people who are yelling that natural birth is the ONLY way and that medical care providers are essentially butchering and assaulting most women in their care. This is unfair and it doesn't help! There is so much fighting and hatred and gnashing of teeth in the name of change that small, easy steps to heal aren't actually being taken as much as pot shots. I have heard midwives called "witches" by doctors, doctors called "butchers" by midwives, and women called "irresponsible" by anyone who feels threatened (essentially frightened)by their desire to birth on their terms. It feels very heavy, almost desperate, and sometimes I lay my head in my hands with sorrow and don't quite know what to do. We have to move through this in a way that makes everyone, birthers and caregivers alike, feel as safe as possible, leaving us all with feelings of integrity.

If how we make choices about birth and how we react to birth is a reflection of our reverence for this mysterious energy that is Nature's design for bringing forth life, we are in trouble. I am being asked more and more to hold support groups for women who feel deeply disturbed by their birth experiences at the hands of well meaning, but disconnected caregivers who seemed terrified of letting them do what they wanted, like birth on their hands and knees or not take pain medication. And if our culture's disassociated, fear-triggered approach to birthing can be seen as a metaphor for the "as above, so below" principle I'd have to say I think Birth is demanding her soul back.

The divide that exists between medical caregivers and consumers who want normal births is this: we birthing customers usually don't see babies die in our every day lives. Our perspective of birth comes from somewhere..well, more normal. Most people don't see volumes and volumes of babies born and witness worst case scenarios, or even the occasional time a normal birth simply ends badly for no foreseeable reason. We are aware that it happens, and we are scared of it happening to us, but it's still all just concept. We are not usually coming to hospitals triggered by tragic experiences of birth loss. Though we are not ignorant (we know bad stuff happens), we do come to birth with a certain innocence. And I think this is okay. It doesn't help us to be armed with terror. Terror interferes with that important oxytocin flow. We come to birth with dreams. Here is where we get to the crux of the matter: regardless of what caregivers have experienced of trauma, resulting in personal wishes and/or sets of hospital rules prescribed to over manage our potentially trauma-filled births, as compassionate as we may feel for the place they're coming from, we still want the right to dream of our good births. And we want to have our good normal births encouraged. Not just in word, but in deed. We want those dreams to flourish without "being put in our place" by the fear projections of the sadly wisened. We do not want our wishes of empowerment and joy to be trivialized by those who have seen it all and would prefer us to not have high expectations for fear of "being disappointed". We want partners in our intent to have whole, happy births, and only saviours if that becomes necessary.

It is somewhere here, between fear and dreams, where something must give and release the pent up emotional energy we're held hostage by and a new way, one rich in safety AND meaning, can emerge. We emphatically DO have the power and the resources to accomplish this. Real healing is essential...and entirely possible.

Stay tuned for part two: How Do We Have Our Cake and Eat it Too?: Retrieving Birth's Soul

Friday, December 9, 2011

A Doula's Blessing for a Beautiful Birth

May your birthing space be prepared in sacredness by those who attend you,
as the Grandmothers do.

May you climb and surf the mounting peaks with a spirit of adventure,
as the Wanderers do.

May you surrender to the Dreamtime and gather wisdom from its messages,
as the Shamans do.

May you roar your fullest Power into being, guided by blessed challenge,
as the Warriors do.

May you open courageously to the earthbound surge of inexorable manifestation,
as the wolves, whales, and bears do.

May you reach, transformed, for the living grail of your fruitful journey
as the Mothers do.

Wednesday, November 23, 2011

When Pregnancy Blows

A lovely client of mine recently made an important observation about the tone of many natural, holistic books on pregnancy and birth. She said, "The statement 'You're pregnant! Congratulations! You are now a sacred vessel of life.' makes me angry. Why is it that the act of carrying a baby is what makes me sacred? Am I not already sacred without the need of a pregnancy to create or justify my sacredness?" Indeed.

I believe the intent of the sacred vessel statement is to help women embrace how great it is to be gestating a kid, affirming that they are special, worthy of extra self-nurturing. It's not malicious. However, this belief that pregnancy renders us sacred vessels puts an awful lot of pressure on women to match this projected beatific state with beatific behaviour...even when they're just not feeling it.

For the most part, most of the women I work with enjoy their pregnancies very much. Sure, they experience some of the uncomfortable symptoms like troopers, but are ultimately quite enthralled with their ripe states. And others absolutely can't stand being pregnant.

I have sometimes heard incredibly judgemental statements from the "You are now a sacred vessel" crowd regarding the women who experience their pregnancies negatively. I have heard people, many whom have never even experienced pregnancy before say things like, "Other women have been trying for years to have children and can't. You should be grateful to be pregnant at all." Or, "Your negative feelings are bad for the baby. You should work through why you are being so negative for your baby's sake." Way to blame! This is the same thinking which blocks a woman's grief over a disappointing birth experience, encouraging her to basically "get over it" because she and her baby are healthy, and that's the most important thing. Well, duh, it's the most important thing. No woman would prefer the alternative of a fabulous birth but an unhealthy baby. But can't we just take a woman's gratitude for granted and give her the space to authentically express her emotions in spite of a good clinical outcome?

Most books on birth don't have a chapter called "When Pregnancy Blows" (though I'm writing one). And I assure you, having worked with hundreds of pregnant women, I know sometimes it really does. Sure, there are some people in the world who are whiners by nature and turn a normal experience into one of abject misery by focusing entirely on the negative. Upon examination, you would see that this is the way they are in their everyday lives, not just in pregnancy. But in my experience, most women do their best to downplay the more negative aspects of their pregnancies for fear of being perceived as ungrateful.

The truth is that sometimes pregnancy is beyond challenging. Sometimes it's downright awful. I have known some women to be so floored by pregnancy that they spend an entire nine months either hospitalized on IVs or lying on their couches wrapped around a barf bowl containing upchucked Diclectin pills. I have seen women literally crippled by their pregnancies, suffering the excruciating pain of pelvic girdle dysfunction. Others develop complications, either minor or otherwise, which turn them from the vital, active women they are into what they feel are bedridden, vulnerable shadows of their former selves, wreaking incredible emotional havoc. To some, the act of expanding in girth is not just a vanity issue, but a deep seated terror rooted in past trauma. Very few women admit this to the general public, but sometimes those whose pregnancies put them into an unusual state of suffering have feelings of "I don't know if this is really worth it," and have literally considered terminating. Sometimes they get resentful of the presence of the baby inside who makes them feel utterly miserable, and begrudge their bodies for "failing" them when their friends are bopping around taking spinning classes until their due dates. Does this make them unworthy of being sacred vessels? Absolutely not.

Many women are shocked when they discover their pregnancies are less than they were cracked up to be because we are so adverse as a culture to talking about it. Letting women know in advance that pregnancy can be really rough on some is not going to make it happen or "give permission" to women to "whine" more about minor complaints. This is the same logic as saying, "If we talk about labour as being painful, then this will make labour painful. Labour is natural, natural shouldn't hurt, and the perception of pain is simply enculturated."

Do these women who suffer greatly feel guilty for these feelings? You bet they do. It is unsafe in proper company to speak so negatively of one's pregnancy without evoking judgement from others who don't understand. I heard one woman on Facebook say that she had had some itchy skin condition while pregnant and SHE never complained, so she couldn't understand why so many women complained so much about THEIR pregnancies, and that pregnancy was a time to be grateful and NOT complain. I'm sure this lady meant no harm and simply has not been exposed to some moms of twins who don't feel as stoic when they cannot lie down at all in the final weeks without throwing up, losing weight rapidly due to an inability to keep down food, or to ladies who are in wheelchairs because of severe pelvic and back pain.

Women who are not feeling great about being pregnant often also feel guilty that their negative perceptions are somehow harming their babies. But I think forcing positivity when it doesn't always exist or not giving vent to some of the authentic feelings that come up, such as extreme vulnerability, anger, resentment, and depression, can create worse problems. Stuffing back real feelings causes stress within the body, and stress has definitely been shown to have an impact upon the pregnancy and Baby's in-utero development. Instead of putting on a brave face when inside she's crying, it's probably healthier overall for a mother struggling with difficult feelings to be able to unburden herself in the presence of someone who will listen with empathy and compassion. Simply being able to have an emotionally safe space held for the acknowledging and accepting of not feeling at all like a sacred vessel can be deeply healing. After all, if you look at it up close, most of the time these feelings are appropriate reactions to crappy situations. If the mom weren't pregnant, the expression of feelings such as these in relation to a challenging life situation would be encouraged. But because she's a "sacred vessel", our culture seeks to look askance at her expression, and it is unfair.

When women repress their real emotions for fear of judgement, they tend to creep up uncontrollably, blossoming into the more socially appropriate condition of postpartum depression. While more well known and accepted than pregnancy negativity, make no mistake; postpartum depression is a serious state and has a far higher impact on the baby at that point. The longer a mother remains depressed postpartum, the larger the impact upon her baby, who very much needs to be emotionally attached to her for optimal development.

As a culture it is important for us to accept and honour the fact that while YES, pregnancy is mostly beautiful, amazing, transformative, and fun, there are lots of pregnancies that just blow. It is usually entirely beyond the mom's control, and she is often sitting on the sidelines wishing she were one of those shiny happy mommies-to-be. If we can meet those furtive admissions of suffering with understanding and compassion, perhaps the experience can be made just a little bit easier. We need to embrace all experiences of pregnancy and be inclusive of all women's feelings, not just the "sacred vessel" ones.

Saturday, November 19, 2011

Doulas: Women of Story

I often tell my students at the end of my doula training program that one of the most poignant aspects of being a doula is about becoming rich with story. Stories of people bringing new life into their families are juicy. They can be mellow or wrought with drama, but they are always meaningful, always interesting. It never fails to fill my heart at the honour it is to be present for the unfolding of each unique and special story. Doing the regular doula stuff, like holding hands, soothing, wiping tears and breathing with are only a small part of the role. It is the BE-ing a witness and participant at the beginning of a family's story, and following up to process it with them, watching them revel in their own reaction to it, that is for me the most meaningful part of my work.

I have held the space for so many stories; triumphs, tragedies, healings, and growth. Most of the stories are wonderful, full of the amazement of women owning their own power as they roar their babies ecstatically into the world. These stories lend the entire world a little grace and our culture a little healing in that moment the mother/s, father/s and child/ren discover each other in an oxytocin haze, a new family member and citizen born. Some stories are of trauma, either due to an unexpected emergency or at the hands of others, these traumas being worked through partly by the doula's gentle whisper, "You have the right to grieve. I take it for granted you are grateful for a healthy baby and will never remind you of the fact to block your tears." A few end in disappointment. "It just wasn't what I wanted." It is what it is and we breathe that in as a reality and work on happy mothering anyway. Rarely, some end before they have even begun. There are angel babies I hold in my heart, having witnessed first hand their passing. I have seen caregivers shaking in shock while I shake in my own and we have sometimes held each other in tears, human and powerless in the face of another's overwhelming sorrow. It is true what Ina May says: your heart will get broken. But I have learned to love better because it, and savour the joys more deeply. A few end in utter surprise with me catching a baby just before the ambulance arrives or before a resident, without backup in an overcrowded hospital, gets her gloves on. Many are first babies, one was even a 12th baby (though it came before I got there, "the fastest yet", the mother said). Some are journeys of deep healing, a reclamation of wholeness to restore faith in one's body that was previously thought to be defunct until the emergence of a precious child. And some are the bitter sweetness of hello and goodbye as the surrogate gives the child she's lovingly carried to his mother, or he goes with the social worker to be given to another family, me left tearful in the wake of some grief, but at the incredible spirit of wisdom and generosity of some birthers too.

It is the stories I have been privileged to have been invited to be part of that make me a woman of story, and which grace me with the honour of being an "experienced doula". It is one thing to start out bright eyed and bushy tailed at the thought of going to births and seeing new babies come out, ensuring a safe, natural passage with your presence. Then it is another to learn the crazy ropes of hospital politics and how to play the game (resentfully at first), as many seem to hate you even before you open your mouth, as well as see that sometimes you can pull out every single one of your cool doula tricks and not have anything go better birthwise for the mother as she goes off for the Cesarean. These are the days of, "What did I get myself into?" when after 40 hours of labour support, your mommy deprived kids at home, and an overburdened partner, you are unsure of your place in this unpredictable world of birth. Then, as you gather up enough story to you and your face becomes more familiar within the places you work, you feel lighter, more in your element, having found your endurance and your stride. You don't feel hated really...maybe just a little misunderstood sometimes, but more appreciated too. And you are able to let go of the fact that you truly don't have any control over how a birth goes. You glean comfort from knowing your support meant that a hard situation will be remembered better, or that the hours, sweat, and tears you put into rubbing someones back through each contraction contributed to that unmedicated birth the family wanted. Finally, even when it seems everyone in the hospital is nuts that day and it feels like nothing you're doing for the family is working at all, you can stand back, breathe, and love. Just love. All of them. Sometimes it's all we can do. And it is good. Good for you, good for them. It is Presence in action, and it is more powerful than you can imagine.

As a teacher I get to witness others as they witness their first births, those first stories being the true initiation into the world of doula-dom. I see the the tears of their joy at seeing new life emerge, the frustration of long hours of pulling out all stops then the birth ending in surgery anyway, the shock of hearing unconscious words or seeing disrespectful treatment sometimes, to them or to the parents, and the bleakness of some family situations. As much as it is an honour to witness birth stories, ALL birth stories, it is an honour to witness others on the path to becoming experienced doulas, to see the shifts that occur as they grow from newbies to women of story. It takes a lot of time and effort to become an experienced doula and to have snippets of story from most situations imaginable, but it is well worth the effort. The more experienced I see my former students and present colleagues become, the more in love with the work they seem to fall. I know I do. Each experience inspires me to recommit. If you're in the beginning phases and feel a little isolated, drop us a line. Sisterhood is far reaching. Here's to you becoming rich in story too.

Friday, November 18, 2011

More Business of Being Born: Bridging the Divide in the Montreal Birthing Community

It is with great excitement Betsy Thomas (of Bummis fame, whom I have had the pleasure of knowing for many years) and I (founder and director of MotherWit Doula Care) are joining forces to bring the first screening of Ricki Lake's and Abby Epstein's More Business of Being Born to Montreal.

There are a variety of reasons we wanted to do this. One is that it is always fun to inform parents-to-be or those considering parenthood about their options for birthing. The film we have chosen to show is one of a series of four, and it is entitled Doulas, Birth Centres, and C-Sections. It is an exploration of the options families have to choose from when making decisions about their birth experiences. Now granted, this film is American, so it will be important for us to put the options into Quebecois context. For example, many women have no idea that giving birth in a Birthing Centre or at home with a midwife is an option that is covered by Medicare here. And others may know this, but may not be aware that by the time their nausea has passed and they begin to think about their birth options, it will be way too late for them to acquire the services of a midwife as the demand for midwifery care FAR outweighs the supply here in Montreal. The vast majority of women who want the option of an out of hospital birth experience with a midwife will not have it. In and of it itself, this is a huge issue we as a community need to address and strive to remedy.

Another reason Betsy and I were excited about screening More Business of Being Born was that a gathering of "birthies" is always a lively, passionate affair. Bringing together the community of parents-to-be, new parents, birth activists, and birth attendants always creates the opportunity for rich discussion. It is through gatherings such as these that positive change can be made towards improving birth experiences for all families, no matter what they choose. It is for this reason I have organized a panel of birth attendants together for an after-screening discussion. I am so pleased to have on board my own beloved midwife for my fourth kid and author of Naissance Heureuse, Isabelle Brabant. Representing the crucial role of obstetric nurses in maternity care is Luisa Ciofani. Luisa has been practicing as a nurse for many many years at the Royal Victoria Hospital and is also a teacher of women's reproductive health as well as a certified lactation consultant. When a woman gives birth in a hospital, it is the nurse from whom she receives the most attention and care. We are also pleased to have Dre. Stephanie Morel from St. Mary's Hospital who is a family doctor specializing in maternal and newborn care. For women wanting a hospital birth but one that is typically lower in interventions and more open to maternal comfort (support for natural birth, support for birthing in mother chosen positions, support for delayed cord cutting and immediate skin to skin contact with Baby), the care of a family doctor is a wonderful option. The obstetrician on the panel is still to be confirmed. This is an important voice to have in a discussion among various birth attendants and consumers of medical care. Many couples feel most comfortable with the presence of a highly skilled surgeon at their births for "just in case" scenarios, and many must have the presence of an obstetrician at their births because of the high risk nature of their pregnancies. It is also important to remember that what contributes to the safety of our midwife and family doctor attended births is the available safety net of excellent back up obstetric care.

I will be representing the role of the doula in maternity care on the panel. I feel very fortunate in my work as a doula, which spans nearly two decades, in that I walk among the different "worlds". I may rush from a water birth with a midwife at Maison de Naissance to an elective Cesarean for a breech baby with an obstetrician. I may be at an induced labour of twins with the presence of a family doctor, an obstetrician, and two feisty nurses and then the next day witness a home birth in which the midwife skillfully catches a fast baby over the toilet. I may transfer with a labouring mom from Maison de Naissance to the hospital for a minor concern, and then continue supporting her while the family doctor eventually catches her baby (a VBAC) while she is on her hands and knees and the nurse turns off the light to facilitate a gentle bonding time for Parents and Baby. In all of these scenarios, my mandate is this: to support a family in having the best possible birth experience within whatever setting and with whatever caregivers are present. In my work as a doula, I have come to deeply value each and every role of the key players in birth attending, and it is with great honour I get to sit with some of them on a panel. Unlike everyone else on the panel, my role is entirely supportive, and entirely NON clinnical. My two cents has mostly to do with my having a deep understanding, given the closeness, hours of contact, and rapport I build with the families in my care, how they feel about their birth experiences; how it was impacted for the better or for the worse by the environment they birthed within.

The theme of this gathering, as well as to watch a highly anticipated new birth movie, is about bridging the divides in the birth community. Many members active in the birth community, from birth attendants to passionate birth activists, have criticisms about other members: their approaches, their choices, their methods, and their beliefs. This is the nature of having strong beliefs and opinions. However, I have personally witnessed midwives bash obstetricians, obstetricians bash midwives, nurses bash family doctors, doulas bash nurses, natural birthers bash those who loved their epidurals, pro Cesarean advocates bash those who want natural birth, breastfeeders bash bottle feeders, formula feeders bash intactivists, and so on and so on and so on. Personally, I'm tired of the bashing. There doesn't seem to be healing in that. What I want to see is a truthful but respectful discussion about what women want for their births, what collectively they have found to be most wonderful or hurtful to their experiences, what safe really means and what a family's responsibility is in making safe choices, and how everyone can work towards making the experience of childbearing as good, as joyful, and as pleasurable as possible NO MATTER where and with whom a baby ends up being born. It is important for people to know where birth practitioners are coming from, what motivates their decisions, what changes can be made to support what families want (and what perhaps cannot), and ultimately how to serve birthing families not only clinically, but supportively as well.

Our evening will be MCed by the lovely Shari Okeke, a reporter who has been with CBC Montreal for over 10 years. She will mediate the panel discussion and keep our evening running smoothly. Essentially, she will be our "event doula"!

Another important intent behind the screening of More Business of Being Born is to raise funds for Maison Bleue, and organization staffed by a midwife (Isabelle Brabant), family doctors, a social worker, nurse, and special educator ( ). These dedicated members work together to create a safe, nurturing, and empowering environment for families living under precarious conditions to birth and parent their babies within, thus preventing many of the associated risks. All profits from this screening will go to Maison Bleue. Representatives from Maison Bleue will be present at our event to take donations as well.

In order to create an opportunity for even more fundraising, small community businesses who serve the Montreal community will donate some of their products/services for a silent auction to be held in the theatre.

The Bummis and MotherWit teams really hope to see you there! A great night for a great cause!

30 November · 19:00 - 22:00
Doors will open at 18:30

La Maison Theatre
245 Rue Ontario Est
Montreal, QC

Please note that space for this one of a kind event is very limited!
Tickets are $15 and must be purchased in advance at: in person at Boutique Bummis:
4302, Boulevard St- Laurent
Montreal, QC H2W 1Z3
(514) 289-9415
*tickets will not be shipped but have to be picked-up at the door on the day of the screening*

Thursday, November 3, 2011

Illustrating the Need for Change

More Business of Being Born, four more films by Ricki Lake and Abby Epstein, is about to be released on November 8th. I wanted to take a minute to reflect upon how Business of Being Born has impacted my work as a doula.

While I was in the middle of watching the original Business of Being Born at a screening here in Montreal, I was called out to a birth. It was a first time mom, who had begun having contractions at about 37 weeks gestation. Right from the get go, things were speeding along, so I had to leave during the scene where the Woodstock hippies are dancing around. I was disappointed that I had to leave what was going to be a great night complete with a long awaited birth movie and a panel discussion, but hey, a baby was on the way. The knowledge that I was going to see a new being into the world quickly soothed my disappointment. I arrived at the hospital and Baby Danica was born smoothly and naturally very soon afterwards to her lioness of a mom.

A friend of mine had bought a dvd of BOBB, so I had the opportunity to catch up on what I had missed.

BOBB has impacted my work significantly. As a birth doula, my concern is with contributing to the necessary healing of our birth culture, which, in my humble opinion, is extremely challenged. Natural birth is seen as radical, and even crazy to the average person. More and more healthy babies are being delivered of healthy mothers via major abdominal surgery, grossly overreaching the 15% Cesarean rate the WHO recommends. The epidural rate for first time mothers in many Montreal hospitals is 98%. The vast majority of women receive some kind of hormonal stimulation to increase the "efficacy" of their contractions. Woman are delivering in positions that are antithetical to the natural mechanics of their birthing bodies. The way labouring mothers are engaged with intellectually, the room often filled with idle chatter or conversations which should be taken outside, when what they need is support for their primal brains to come to the forefront, impinges upon the natural flow of oxytocin, thus impacting a birth experience for the negative much of the time. Birth is essentially contained within an environment which places far more trust in the technology and medications than in the process itself. Ultimately, though, what frightens me the most is how the average woman views even the idea of normal birth as something actually unnatural, really having no idea of what the physical/emotional/and psychological benefits of normal birth are. When normal, physiological birth is held in contempt even by the women themselves, it is clear we have lost our way.

Business of Being Born serves as a critical and necessary change agent, illuminating the problems with modern North American birth practices. It teaches us how despite our oodles of technological obstetric know how, medications, and hospital beds, our birth outcomes are inferior to countries such as Holland and Norway which use midwives to support normal birth, and obstetricians mostly for treating pathologies in birth. The film shows evidence of the iatrogenic problems that can arise in birth when there is simply too much medical interference with a process that goes normally the vast majority of the time. We also get a necessary wake up call by witnessing American women being interviewed at random in New York City, being asked if they'd ever have a midwife. Not only do most say "no", but many look startled and begin extolling the virtues of planned Cesareans because they eliminate the big messy unpredictability of childbirth. I know many women AND obstetricians who watched this film with eyes wide open, the glimmering of an understanding of how essential change is if we want to protect the act of straight up, garden variety, unmedicated vaginal birth from becoming obsolete. Because honestly, in North America, we are almost there.

Not only does Business of Being Born depict the problems and illustrate the need for change, narrated by midwives AND obstetricians, it also lets us know how deeply moving, empowering, and incredible natural birth can be. Yeah, it hurts. Fair enough. But how that wonderful dance of hormones and baby love transforms women into powerful mothers when the journey is over is at the heart of this film.

What I found most important about Business of Being Born was that it isn't just a film which preaches to the choir. Sure, every "birthie" in town saw it, but so did many pregnant women and mothers who were not yet "converted" to regarding the possibility of natural birth as a desired thing. This film reached out to everyone, and many heard the message loud and clear. Personally, my clientele increased because more women were now savvy of what to expect for a hospital birth and wanted to come in with a presence who supported their desires for their experience, as well as honoured the safety net obstetrics and hospitals are seen to provide. BOBB emphasises how critical the support of a doula is for birthing, especially in hospital birth. The presence of a doula helps to increase one's chances of a more positive birth experience. Many of my initial contacts from my clients begin with their saying, "I watched this film called Business of Being Born, and I need your help to give birth within the hospital system".

One of the greatest gifts of this film, I felt, was the sharing of the personal birth stories of the creators, Ricki Lake and Abby Epstein. Ricki Lake is a well known public figure. She's been in films and has her own talk show. She discussed the birth of her first child, which was a hospital birth and not something she felt went the way she wanted. So she chose to have her second baby at home with a midwife. She honestly describes the struggle and pain of her natural birth, and her desire to quit a few times, as most of us do in labour, yet keeps on going with the encouragement of her partner and midwife. Ricki generously shares with us the image of her naked self in the bathtub of her home, birthing her baby, as something natural, beautiful, and absolutely triumphant, as an experience that helped her reclaim the power she felt she didn't have during her first birth. Hers is a story of healing and inspiration. Using her inspiration and her status as a public figure to illuminate the challenges of our birth culture, giving us a glimpse of how amazing birth can be by showing us her own story, has inspired thousands upon thousands of women to examine their own desires for their births. I wanted to stand up and applaud that someone whom, as a celebrity, celebrities being mostly viewed at the "too posh to push" types, was willing to share something so intimate for the purpose of illumination.

Abby's birth story happens near the end of BOBB. She goes into premature, very fast active labour with a breech baby. We follow her from her home where her midwife lets her know it's time to get to the hospital, to the lobby of her apartment where she is on her knees of the floor vocalizing with her friend Ricki doula-ing her, to the cab in which her waters break. She makes it to the hospital in time to have the Cesarean she and her obstetrician have agreed upon, and delivers a baby who is very underweight and with major breastfeeding challenges who has to spend time in the NICU. While she is sad that her experience was not the birth she was hoping for, this part of the film does clearly embrace the fact that problems DO occur in labour, and that our safety net of hospitals and obstetricians are clearly a good thing that we can celebrate, even as we move as a culture towards the idea of exploring more natural options for birth.

Business of Being Born presents two distinctly different worlds: midwife attended natural births, mostly at home, and highly medicated hospital births with obstetricians. One of the criticisms of the film I encoutered was that it gave Medicine a bad rap. Some of my doctor and nurse friends felt hurt. While they know there definitely major problems with the hospital system, their intent is never to do "bad" to mothers. As a developed nation, we do have the luxury of embracing home birth as a great option because of the safety net obstetrics provides if complications occur. They felt there was a suggestion in the film that midwife attented home birth is mostly good, and OB attended hospital birth is mostly bad. I would like to see a world in which both choices can be consistently fantastic and meet every mother's personal needs/desires.

As a doula, my challenge is to strike a balance between the two worlds and embrace the possibilities in both. While I do get to work with midwives outside of the hospital, the vast majority of my clients are hospital birthers. Many of these women wish to have, or must have due to health risks or lack of midwifery resources, their babies in the hospital. There are no pools to birth in, no opportunities to birth on the floor or a bathtub or by the side of the bed, and a lot of interruption from strangers. My goal is to bridge this gap, to facilitate the best, most natural birth process we can within this challenging hospital environment. A lot of the time, while women still receive the benefits of my tlc, they don't have the birth they wanted because they simply didn't have the control over the environment they wished to. I can do my best, but it takes two to tango. For the best hospital birth possible, medical caregivers need to be on board and respectful of the mother's wishes. There must be more openness to the mother's desire for more control over her environment, such as remaining quiet and observant whenever possible, following the mother instead of insisting she do what is easiest for the caregiver, and encouraging unmedicated birth if the mother wishes as well as unrestricted bonding with the newborn. The wonderful thing is that an openness is just beginning within the hospital system, as evidenced by many of the happy births I have been witnessing of late.

This is the exciting thing: several doctors I work with have seen BOBB as well. While it is never easy and can make one initially feel prickly to be lumped into the collective "problem" and negatively scrutinized when all you're trying to do is your work of keeping everyone safe and actually doing some great life saving work, I have certainly seen the acknowledgement of the need for change, and some changes in action. I have seen a general shift of more consciousness towards protecting the experiences of the family, more openness to women birthing naturally and in different positions, and more compassionate treatment. Many of the physicians I work with agree that the medical system is extremely challenged. While they are going to continue doing what they do, there are more who are trying to do it in a way that honours the importance of the experience of birth, not only focusing on a good clinical outcome. Obviously, as a mainly hospital birth doula, this shift in consciousness impacts my life immensely for the positive. While challenges are still rampant and there is much work to be done, I do feel the tides turning slowly.

In my lifetime, I doubt I will see a mass exodus from the hospital back to a homebirth majority. But hopefully I will see an environment where women can have what they feel is the best of both worlds: mostly uninterfered with, undirected births, but with quick access to the medicine and technology they want close by. If Dr. Michel Odent could create this environment within his clinic in France and enjoy both fabulous clinical outcomes and triumphant new families, maybe, just maybe, we can dream this hope into reality in North America for those who want and/or need a hospital birth. I am myself a home birther. This is where I feel safest and most confident. I am an avid supporter of the midwifery model of care, and hope there will soon be enough midwives in and out of hospital births to meet women's demands for them. But most women don't feel this way in North America. These ladies who prefer the hospital make up the majority of the beloved clients I provide support for. For the sense of security they get from being in the hospital, which is essential to their personal sense of safety, it is my wish they should never have to pay the exhorbitant physical and emotional price of having their decent birth experiences potentially put at risk with an often overuse of medical interventions without proper informed consent, an impersonal environment, and caregivers who are sometimes unaware of good birth etiquette. So instead of dividing the two worlds, for the sake of most women and not just the ones who are on either end of the majority, I strive to work on healing the divide so that everyone can have the best chance at a beautiful birth.

It is my greatest hope that this impetus towards a healing of our birth culture continues. The more awareness we bring to issues in and potential of birth, the greater the healing will be. I offer many thanks to all the creators and participants of Business of Being Born for having generated this necessary awareness on a huge scale, and am very much looking forward to More Business of Being Born to keep the momentum going.

Lesley Everest

Thursday, October 20, 2011

MotherWit Doula Training Toronto

I am so pleased to have been invited to teach the MotherWit Birth Doula Training Intensive in downtown Toronto!

It has been a passion of mine to bring my training to different cities in intensive format. I believe it is extremely difficult to learn the basics of how to be a doula in a weekend workshop. Ideally, a training of a couple of years would be more ideal. However, this is often not a format that works for busy mothers of younger children. Mothers and babies need to be together as much as possible, so I believe that it makes sense to be in a room full of women and babies as we learn how to tend to women and babies. So we do this more grassroots and oldschool...we sit around in the beautiful chaos of nurslings for six days and three evenings (meaning 3 eight hour and 3 twelve hour days), burning the midnight oil so to speak, as women do, as we learn the ins and outs of the role of the doula as being not just the lady who rubs a woman's back and spritzes her with lavender thoughout labour, but how to be an agent of real change when it comes to healing what is clearly a very challenged birth culture. We learn how to navigate a challenging, regulated, protocol/policy based hospital system to help a woman have the best chance of achieving her goal of having a natural birth (if this is indeed her goal). We learn about what healing means for each individual woman, how a great birth experience is not one which reflects a perfection of extremes, but one which makes the mother herself feel amazing and powerful on her terms.

Our goal? Happy mummies and daddies. Why? Because they tend to have happier children. And happier children tend to grow into adulthood more smoothly. When parents are left aching and depressed over an unsatisfying or even traumatic pregnancy, birth process or postpartpartum period, this has an impact upon the family structure. A doula's presence is known to create birth environments which parents find more satisfying. That satisfying experience is how we hope our humble role creates that ripple effect into the child's adulthood, perhaps even creating new legacies of happy births for generations to come. A good clinical outcome is obviously paramount, but the experience of birth for parents is incredibly important as they transition into being a family. Our work is about protecting and nurturing this experience, about working with the family to discover what they need for the best experience possible. And when things don't go as planned or hoped for, a doula is there for them to lean on to help process the experience and draw upon the parent's strengths and triumphs for speedier healing. Our kind, conscious, loving attention can buffer a lot of the pain involved in challenging birth experiences, again creating a better chance of parents and babies beginning their lives together from a place the feels whole to them.

Doulas are essential to helping not only healthy families have normal births, but to be an anchor of emotional support and comfort to women who come from very challenging places, having suffered abuse, violence, and abandonment, and/or experience very high risk pregnancies. We are steadfast in creating a space of emotional safety within which a woman can birth on her own terms according to her own needs. We can buffer fear, generate love, nourish health, and provide comfort to women who are suffering. We do this without judgement, honouring each woman's unique path.

Doulas, despite popular views, don't eschew modern medicine and technology when it comes to birth. Most of us have been there ourselves. Yes, we do believe the vast majority of time birth goes normally and needs little to no intervention, and we respect what is important for our clients to feel safe and supported. Most of our clients prefer to give birth within the hospital system with quick access to technology "just in case", so in support of them, we ensure they have knowledge of the procedures and protocols ahead of time, we encourage them to research benefits and risks of each procedure, let them know what is realistic to hope for, and encourage them, with the help of their caregivers, to research their options. This gives them the best chance of giving their informed consent or refusal, and increases their sense of empowerment. We never tell our clients what to do. And we don't fill them with fear of the hospital system either, as creating fear for the environment within which a client will birth is not condusive to that wonderful oxytocin flow they need for their labour to go as smoothly as possible. We outline the reality of the system, and this may sometimes seem scary to some, but we help clients to rally their resources to work through their fear, suggest ways to make them as comfortable as possible, and clarify their desires with their caregivers. We do this instead of adding fuel to the fire by suggesting hospital routines are a "bad" for those wanting a natural birth. I have seen many exquisitely beautiful, triumphant, amazing natural births in hospitals, so I know good support can transcend some of the challenge these routines create. I have also seen sacred Cesareans and epidurals being nothing less than a blessing, either by advance choice or surprise. The doula's support of a woman's sense of emotional safety is essential for her birth to be perceived as a good one for her.

A sense of community is extremely important for a doula to thrive and grow given the intense nature of this work. As we spend six days together, a sense of community and sisterhood grows, ensuring students have other new doulas to conect with after the training so they don't feel alone. My mentorship extends to after the training as well. Clearly I cannot take on apprentices when I train outside of Montreal, but I can still play a role in being a support person for new doulas, and encourage them to find experienced doulas whom they can shadow for a few births to learn the ropes. Mentorship and support are at the heart of the MotherWit Doula Training, as being a doula from a place of isolation is extremely difficult, and not condusive to growing into the practice as happily.

We also have a LOT of fun at our trainings, which are full of laughter, herbal infusion tasting, massage oil making, essential oil sniffing, massage giving, and most importantly, story telling. Women are story tellers. We learn and grow through a tradition of narrating our lives, our triumphs and woes. As doulas witness the birth of families, we become story keepers, which is a role I take on with great honour. At the end of my days as a doula, my greatest accomplishment is being rich with story. I wish this for you, that you are rich to bursting with stories of triumph and healing through birth that will be passed to the next generations.

If you are interested in becoming a doula, come check us out in Toronto from January 3rd to January 8th, 2012. Specifics about our training can be found at this link

I'm looking forward to hearing from you!

Thursday, October 13, 2011

"You Have to be One Tough Bitch to be a Doula"

...This is the learning my recent students took most to heart....

I had the privilege of being invited to teach the MotherWit Birth Doula Training Intensive in Edmonton at Birth Source Inc, hosted by Tracey Stolarchuk. With great excitement, I packed my bags and flew on over from Montreal. At the airport, I met up with my friend, former student, and doula sister Sue Appleton Elliot, who is a birth doula at Apple of Your Eye Doula Services in St. John, New Brunswick. I was overwhelmingly grateful to have Sue's grounding presence, because I was nervous. Very nervous. Not because I was about to teach a 60 hour doula preparation class in six days, but because I was minutes away from seeing my father for the first time in over 15 years. I was so glad not to have to do that alone. Not that I was dreading the meeting, it was just so surreal.

Meeting up with my dad and his wife was lovely. It did my heart good to see my father doing well and living a life that satisfies him, having existed in the throes of terrible addiction for most of his life. I'm pretty proud of him for having climbed over a huge mountain of struggle to choose a healing path, and am amazed he made it out alive. He was proud to hear of a new grandchild (my sister's) and her marriage last year. We spent that evening having a lovely supper with them, and my father made plans with me to meet for dinner later that week. I had put Sue in charge of teaching that evening's topic so I could spend some time with my father.

It is always so exciting to meet in person the women who have, out of all the doula trainings available in North America, chosen mine to put them on the path to this crazy work. It makes me feel extremely humbled, and extremely responsible. You certainly can't teach someone how to be a doula in 60 short hours, but you can give them the overview of how to proceed, and set the tone for the beliefs they may bring to the birthing rooms they visit in the future. I was happy to see a feisty, dynamic bunch with lots of stories to tell. I knew we were going to have some fun.

My message is always very clear, that a "holistic" birth doula is not someone who believes an undisturbed environment and a healthy spritz of lavender will create the perfect birth outcome all the time. The fact is, most women in Canada give birth in hospital, and the fact is, most women want to, even though it reduces the normalcy of the process. So our work has to be tailored in support of each individual woman, in support of each environment she chooses to birth in. A good, healthy birth honours not only the precious biological blueprint of the birth process, but the resources, inner and outer, a woman brings to birth. An all natural birth can be an incredibly healing journey for many. Yet for others it is potentially an endeavour in terror, flashback, and trauma. We meet women exactly where they are, in love and support, and provide the most comfort and encouragement we can as she brings her baby into the world, on her terms, in her way, from her place of empowerment. If she comes through feeling amazing and powerful, even if it doesn't match our vision of "perfect", then this is healing and trans-formative for her. We rejoice. And if she doesn't feel that way, we are there to lean on to help her sort things out. A holistic doula nourishes the whole woman; her strength, her fears, her challenges, her choices.

After the first day of the training, I read a blog our hostess Tracey had written. It talked about her retirement from doula work, and that her parting gift to the new generation of doulas was the MotherWit Intensive she had invited me to bring to her home town. I felt an even stronger commitment to bring my absolute best to the women who wanted to learn, to live up to that faith someone I admire very much had in me to enrich the knowledge of aspiring doulas. I took that challenge and opened up, way up, and gave from a more spiritual, more emotional place than I have in the past, committing myself to my own authenticity, as I challenge my students to connect with and commit to theirs.

I looked around my group and it was clear what the theme of this training was going to be: "strength". Every training I have takes on a unique flavour. My first intensive expressed the impetus for building a strong community within which to learn and thrive, so the flavour was "sisterhood" in my mind. My second intensive was mostly full of strong, young, childless women who were inspired through their work and studies to help women birth on their own terms in a challenging environment. "Empowerment" was the flavour of that training.

I don't mean this Edmonton group was strong the way women are generally strong. These were women grounded in some serious ferocity. This was not a room full of hippie dippie patchouli doulas. These were women who have been around the block more than a few times and have held the space for some serious things in their lives. One lady had been in the Canadian Reserves and lives on Edmonton's military base, raising her three babies while her man is away in Afghanistan. There were a couple of nurses who are no strangers to pain, struggle, and every hard emotion under the sun. There was a drug and alcohol counsellor who compassionately sits with people when they have to detox from things like Listerine, as well as support them emotionally to get their lives back on track. We had a newly pregnant child and youth worker who flew all the way from a tiny island on the Bay of Fundy to meet with us in Edmonton. She and her husband were caring for a nephew at home whose mother was very sick. Sadly, the kid's mom died during the training, and my student will be going back home to support a child's grief. There was a woman who has worked in forestry for a decade. These are just some examples of the women who made up this incredible group.

What I loved about these women the most was that even though their strength was palpable, it wasn't harsh. They had the most loving hearts, and I know they will make any woman in their care feel totally safe, but really nurtured as well. And, wow, such amazing mothers these ladies were. I loved watching them all with their babies and toddlers.

The last day of our class is always a challenging one, as we spend time discussing the hardest aspects of birth attending; witnessing trauma, death, dealing with anger at a system that often isn't even conscious of some of the deep wounds it perpetrates sometimes, as well as how the intense enery of birth can launch us right into countertransference, opening up old wounds we didn't even know we had. I was already coming from a pretty raw place. The evening before, I was ready to meet my dad to spend some time with him, after 15 years of our not seeing each other or communicating much. I called him to see if he would be picking me up from the store after he finished working as we planned, his place of work being 5 minutes away. Apparently he had forgotten our plan. I pretended there hadn't been a plan so he wouldn't feel bad. I had to take some time to process that. For a while as Sue drove me in respectful silence back to our hotel, I felt like a kid who found out for certain that Santa Claus wasn't real. It's not that I had any expectations of my father suddenly being like a father...but maybe a little young part of me secretly hoped for it. I don't blame my dad. He is ageing and forgetful. But the truth is that we are just not part of each others' lives. This is not out of malice, but because even though we're related, we don't know each other. He was too sick while I was a child to ever be able to safely relate to him. I breathe that truth in. It is what it is. So a little time alone and a good cry of letting go with my husband over the phone, and I was able to come to a place of a better understanding: that I truly am a girl with no daddy, but that I do have a father who is doing his best in the world as a person and has done some mind blowing work to heal. He is kind, generous, and he is with a great partner. I like that. It is my responsibility alone to do with my feelings what I may, and blame certainly isn't going to be my choice.

As I was preparing the class a little later, it occurred to me how doulas often have a community of other doulas to process hard stuff with each other, because women naturally gravitate towards each other for emotional support. It made me wonder what doctors do. So I messaged by OB resident buddy for a chat about that. Yes, it is true, doulas and OBs probably do seem like strange friends in theory, but I have found this relationship to be quite healing, as well as inspiring. We swapped some really sad birth stories, and I learned that his greatest emotional support when birth gets tough comes from the nurses in labour and delivery, who are truly like moms to residents. I was happy to know that, and truly, not surprised. Nurses are pretty amazing, after all. I think it must be hard for doctors, who, given all their clinical responsibility, can't really hold a woman's hand in the face of emergency and cry with her afterward because they have to keep such a strong clinical perspective, yet their pain at what happens to their patients is just as acute as mine is for the sadness my clients experience. I feel doubly blessed for my community of doulas, and open our circle up to any doctor who needs a hug and a good cry when the dust of clinical trauma settles and the emotions begin to rise.

After a hard afternoon of painful topics on our last day of training, we talked about the qualities of a doula, and this is when it occurred to me how the hippie image of the doula is so incredibly whack. Media has it all wrong. We joke about it because while it's true we might be a little weird, most doulas I know aren't hippie-ish at all. I looked into the eyes of every one of these fierce women in front of me, and told them: "It takes one tough bitch to be a doula. When you have done this work long enough, you WILL see trauma you can barely contain, you WILL get your heart ripped open with grief, you WILL feel anger so strong at the sight of mistreatment, you will want to hurt someone. I WILL commit to continuing my work. I HAVE had my heart broken, yet I do it anyway. I HAVE experienced rage I've had to struggle to transform into love for those hands that will catch a new life, yet I commit to staying present, knowing it will probably happen again. This is my path, this is my choice, and this is how we can help to heal this culture, by choosing again and again to open ourselves up to love even when it hurts." Not one person flinched. Nobody turned around and tried to get out of Dodge as quickly as possible. Every set of eyes looked back at me with determination and even inspiration, and the words of a very wise mother in the room resonated from a guided imagery exercise we had done earlier in the day: "Love transcends all need for understanding." When the father is in pieces, if the baby has died, when a woman feels raped by an experience we couldn't control, when everything hits the fan at once, our role isn't to flesh out the reasons why. That's for the caregivers to do if it's even possible. Healing comes for and from us in the form of love; from the act of giving and receiving it, and from the sense of feeling worthy of it, even at our lowest. It reaffirmed to me the greatest compliment I have ever received after attending a hard birth: "You made me feel loved. When others couldn't meet my eyes, you loved me."

One thing I try to do in my trainings is introduce the concept of ritual or ceremony. Women, who used to cycle together and celebrate days of harvest and full moons together with ceremony, are particularly hungry for it. If we burn a little sage in class, eyes tear up at what seems to be an ancestral memory. My Edmonton ladies have already found ritual, as evidenced by the many awesome tattoos I saw (and I'm sure there were a few I didn't see). Many people judge people with tattoos, especially when the tattoos are sported by women. But really, with the world out of balance, commerciall-y baby showers taking the place of Blessingways and birth being something to schedule for convenience instead being seen as a woman's rite of passage into motherhood, it makes perfect sense to me why women would feel a deep desire to transform much of their emotional pain and personal experiences into body art through the process of enduring physical pain. This is a more ancient, less cerebral impetus towards healing. It doesn't have to make sense.

I wanted to take a moment to honour and celebrate the tattoos of my students. They all have stories, even if you may not understand their meaning by looking at them. Some tell stories of commitment, others of survival. A couple of them move me incredibly. One woman connected to our group lost a child years ago. Yet colourful butterflies of hope and transformation fly on her skin forever. How healing is that?! And beautiful. The one photo you see at the end may seem like the funniest, silliest tattoo ever, but make no mistake. If you knew this woman and her life, it is a profound message of surrender, serenity, and the gift of humour.

So, my inked up little Albertan badasses, love to you all. You are all tough bitches, and I mean that in the most loving way you can imagine. Go out and doula. It was an honour to meet each and every one of you. Merry meet, merry part, and merry meet again.

Saturday, August 20, 2011

Tools for Change in Birth: Grace, Love, and Healing

"...{Grace} is energy infused with a force greater than our own, a divine intention. When it arrives-usually unannounced or unrequested 'out of the blue' - it fills you with a luminous awareness that is different from everyday consciousness; it makes you come alive with vision and determination and the strength to act." -Caroline Myss

If there is anything I love about attending births, it is being witness to an act of Grace. If we regularly looked at life in more symbolic terms, birth would be honoured as the sacred rite of passage it is. Rarely is there an event in life where someone has the opportunity to dance with a massive force which, if you choose to dance, will raise you incrementally into an altered state, make you lose your inhibitions as you surrender your regular self to its pull, swaying and chanting, beguiling your body and mind to lose your everyday control, opening your body in extreme vulnerability but at the same time coaxing your fullest strength, and lifting you ecstatic and triumphant, with a new life in your arms , your identity changed forever.

I think the main reason I love attending births so much is because of the hits of Grace I receive, which are healing for me as well as for the one who births. I get to connect with another human being in the deepest possible way, witnessing a sacred act of creation work through her. She doesn't need me to control anything at all about her experience, but I can help her to feel safe and good about what she's doing when she questions what it's all for. She usually has a safety net of a primary caregiver to keep her and her baby physically safe, and my role is tend to her emotional safety and comfort. Through my connection to her, I help her to forge connections with the presence of everything that's there, not just nursing the pain, exhaustion, and challenge that are inherent parts of the experience and the ones our culture focus on the most. I try to guide a connection to the pleasure, confidence, reassurance, sensuality, and ultimately, Love, as connection these qualities bring beauty and strength to the experience.

There is nothing easier to me than loving a lady in labour. Even if she and I have nothing at all in common in our everyday lives, when Birth comes calling her to dance, regardless of how she dances with it, be it openly, resistantly, loudly, grouchily, or meditatively, she is in the presence of something incredible, and is worthy of unconditional love and support. I want her to feel entirely safe about doing what she needs to do to get through the journey, and know that she can look into my eyes to check in to find grounding and validation for how wonderfully she's dancing. My intention is for her to learn the lessons about herself presented in her unique dance with Grace, apply them to her life as a mother, and hopefully, to have her enjoy her ride as much as possible.

Everyone who is on the path of being a birth attendant has a unique Medicine they bring to the experience. Some have the ability to use their hands to calm, reassure, and create relaxation. Others are really connected to plants and know intuitively how to apply that medicine most effectively. Others generate the most healing with word medicine, sensing the right words and tone to bring peace and guidance. Some are particularly talented with surgery or other physical manipulations to manage and heal challenges in birth. I truly believe that these medicines are at their most effective when they are inspired by and applied with love. We can read about the correct words to say (or not say) or learn about why homeopathic remedy A is best for symptom B, or practice delivery techniques until they can be done in one's sleep, but it is love, based on a profound understanding of the woman and her experience, which empowers and enlivens the medicines we apply. When the woman feels loved and that her supporters are working from a place of compassion, whatever the outcome, her experience of Grace,and the healing Grace bestows when everyone is aligned with it, is increased. We all become part of this very special experience, and we imprint upon it for life, as we ourselves are imprinted. We all get to carry home a little bit of that Grace with us too. Empathy, compassion, kindness, and giving of ourselves for another is probably really healthy for us physically and emotionally. I know that my work makes me thrive and touches every aspect of my life, making me stronger, smarter, and more loving.

When students of doula work choose to use me as a resource in the hopes of furthering their learning, I let them know I'm not as concerned about how much they know or how "perfectly" they may execute a double hip's the quality of their touch, the quality of their presence for another person that is more important...their willingness to open their hearts vulnerably in love. It's about their willingness to explore their own unique "medicines", and discover not only how they can bring healing to birth, but how attending births heals them. The more we commit to healing ourselves, the more clarity we bring to our work, and the more profoundly we open to birth's Grace, which in turn generates even more healing on many levels for everyone present for it...whether those present are aware of it or not.

Maybe, just maybe, love can be part of the momentum that generates enough power to shift the pendulum of our culture so that the experience of birth is owned again by the birthing woman herself, and those that care for her are there to honour and trust her power, intervening only when warranted. This in no way means we have to give birth in huts again (unless we want) or eschew all technology if that's what's wanted or necessary...that's a perfectionist sense of owning one's power in birth. It simply means making the woman and her physical/emotional/spiritual experience the focal centre of birth again. Because right now, our cultural idea of supporting birth seems to be much more about Machine (paperwork, insurance companies, fear based protocols, iatrogenic patterns that give us as a developed nation comparatively unimpressive birth outcome stats, intimate procedures done without bothering to inform or ask for consent, contempt for "demanding" or non complicit patients/clients who want to "endanger" their babies by having "natural" or "medicalized" births, supporters who believe their way is the best or only way and push personal agendas and behave combatively) than Medicine (healing, support, compassionately applied technology, understanding of the deeper aspects of the birth experience, honour for the importance of the birth experience to be as good as possible for the greater health of the new family, supporting what is present right now, love). There is much change to accomplish. I'm game. "There but for the grace of god, go I."