Monday, February 27, 2012

After Training High

Those who know me know one of my greatest passions is to guide women on their journeys to becoming doulas themselves. It's not just because I love to chat about birth and see eyes open big and mouths open in wide "Os" of wonder (though that's a large part of it), but because I feel that having more women aligned with what birth in our culture needs for healing MUST reach critical mass. I feel a desperation to see the pendulum begin to swing the other way, ensuring within the context of the great access to modern maternity care we have, ALL families experience birth in ways which nourish them.

There are too many stories of emotional trauma, too many choking sobs at the telling of birth stories, too much shame surrounding the experiences of mothers and fathers, stories which, had the tellers been honoured in the spirit of "bringers forth of life" instead of "ignorant inconveniences", could have ended in triumph. Sadly, many end in the frustrated, guilty tears of those who feel they don't have a right to grieve while healthy babies lie in their arms.

Before I begin a doula training, I take time to connect as deeply as I can with my intent. What do I want for these women? I am humbled by the amazing women who decide to come to me to help them further and focus their aspirations to embark upon this work, and I have an overwhelming desire to serve them well. I believe my students all come with a deep yearning in their hearts to be of use, to do what they can to serve families as they contribute to the healing of Birth. They usually come for three reasons: either they've had that sip from the Holy Grail of "Transformative Birth" and want that for everyone, they have been deeply wounded and want to prevent that sadness for others by buffering and supporting, or they have experienced neither but intuitively know the stories they're hearing need to change, and want to be a part of that good change. Not only do I want to give them skills and knowledge to do so(learning myself from the amazing depth of skills and knowledge they already have), but I want to connect them more profoundly to their own feminine wisdom. I want to nourish that deep soul yearning they bring to our learning circle. I want them to feel in their cells how their inspiration to work as doulas is the prayer of their great great Grandmothers. So we work with that part too, exploring ceremony and energy work as we honour the inspiration that sets us on the path of Love and Spirit.

I love the way women gather. I observe how they interact. Before names are even exchanged, a woman will take another's baby so she can take off her carrier and coat, both of them happily chatting about early motherhood. Offers of holding babies are freely given so mothers can eat hands free (a rare treat). Coffees are poured for each other, resources are shared, tears dried, hugs exchanged, and acknowledgements of the great feeling in the room uttered. The talk is earthy, laughter filled, and bawdy as we let down our hair away from the presence of older kids and gentlemen. Women are capable of generating a lot of amazing energy in their gathering, an energy born of the simple being in community with a shared dream. And when that energy is focused with a collective intention, great shapeshiftings of heaing occur. I know many of these women will go home and experience some amazing synchronicities and come back to our next gathering with stories of more deeply honed intuition.

Today, after teaching half of our eight day birth doula training (the rest happens next month), I am physically and mentally exhausted, but I am on an emotional high as if I've just worked long and hard for an amazing birth. Thank you all, Ladies, for bringing your beauty to our humble gathering space within which to hone your own motherwit. Merry meet, merry part, and merry meet again.

Note: For anyone who finds themselves all freaked out at the sight of doulas feeling bellies and listening with a fetal heart finding device, have no fear and relax. We are not out to do midwives' jobs (otherwise we'd go out and be midwives), nor are we trying to assume any clinical care of our clients. My students are literally under contractual obligation to perform NO diagnostic skills on their clients. We nourish the whole and provide information and support. We like to promote optimal fetal positioning. There is a lot of controversy as to whether or not there is value to this, as many babies turn posterior during birth..but because of the fact we see a large percentage of natural births, we also see (as anecdotal as it may be) that many of these malpositions during labour occur after mothers receive an epidural. We know that for moms who have healthy, normal pregnancies and their babies are determined by their caregivers to be head down and stable, the principles of OFP may potentially contribute to a smoother birth. Can we tell where babies are lying in their mom's tummies? No, of course not, that takes years of midwifery/medicine experience. We ask Moms when we are asked if we know where their babies might be upon our discussions of OFP, "Where do YOU think your baby is?" We ask where the mom feels kicks and a bum, and if she wishes, we feel along with her. It is in the spirit of bonding, exploration, and empowerment,and helps moms get accustomed to our touch, establishing a deeper rapport that we bring to her birth experience. To validate to Mom that her instincts were right on, or to perhaps explore further if she is unsure, we invite her to listen to her baby's heart, having her place the device over where she thinks Baby's heart would be heard. Parents love to listen to this, and their eyes light up when they realize they figured out the mystery. Never is anyone listening to the heart rate for any diagnostic reasons, nor are doulas ever trying to diagnose position or lie. If nobody hears a heartrate, we know it's because none of us know enough to find the right spot, no big deal. When parents ask about their baby's positions, most doctors tend to consult the ultrasound papers and say, "it's head down" and that's that. So discussions about fetal positions and their being proactive about it piques their curiosity to know more about their bodies.

This is for fun, information, and for parents to feel more involved in the understanding of their pregnancies and how they can potentially help themselves have a smoother birth. If they find Baby be in a position that may be less favourable for a smooth birth, we discuss and demonstrate exercises for moms to do.

Doulas are very intimate with their clients' bodies, massaging them throughout labour, drying them off when they're getting out the shower and are too busy with their labours to do so, dangling them on our laps to help bring Baby down, suddenly seeing a baby's head in her vaginal opening and yelling for a doctor, positioning their bodies to facilitate changes in position, drying tears, wiping blood off their legs, changing soiled bedding, holding vomit bowls, touching breasts, showing how to diaper and swaddle their babies, holding their babies when put a taboo around a belly with a baby in it is a silly silly thing if this is our client's desire. There is often the assumption that if you give a woman some knowledge she'll go off and do dangerous things with it. Feeling bellies is not a "Gateway Touch" which shoots doulas over the line into playing midwife. The Spanish Inquisition ended a long time ago.

Thursday, February 16, 2012

A Doula Mentor's Dilemma

I recently attended a birth with an apprentice I chose specifically for a certain couple. Why did I choose this particular student to accompany me? All I can tell you is that I had a feeling. I have many students who enjoy attending births with me, but this one lady came very strongly to mind when I envisioned who would be a good fit for this couple.

My gut feeling registered funny in my head though, because really, the student and the couple were very different personality wise. My student is very quiet, gentle, and kind of shy in a sweet way. The couple is straight up, have no qualms about dropping f-bombs, and are expressive and raunchy (all in a great way).

I also encountered a bit of an ethical conundrum. My head kept saying that I should be very careful about taking a calculated risk with my apprentice's heart because of her own life stories. On the one hand, I knew our client's GREAT birth experience would bring some healing and inspiration. On the other, a challenging, disappointing birth experience could potentially bring up a lot of painful and discouraging feelings. As we can never predict birth, especially one of this particular nature, it was not "low risk" for my apprentice. All I knew was that it felt really important for this student to be there. Whenever I would think of bringing on someone else whose own personal history rendered them "safer" emotionally if this birth didn't go well, I kept thinking of this student. I outlined the situation to her, and she agreed, admitting that it could be a challenge, but that she was willing.

The couple really liked her presence, and were generous with their inclusion of her in their prenatal/birth experience. She is a quiet observer, but still waters run deep. I feel like she provided a sense of deep listening and compassionate grounding for this couple. There was something in having a commiseration about past birth experiences that I think made my clients feel secure with her. Not that my student talked about her stories in detail at all, but the general gist was something I knew the couple appreciated. When labour was getting stronger they asked when she would be there, so I was very pleased with the connection.

Sad to say, the birth, while everyone came out healthy and sound, was not even close to the experience I had hoped for either as a doula or a mentor. To make a very long story short, we all ended up witnessing (and our clients being the victim of) one of the worst abuses of medical authority I have ever seen. Of many of the things I specifically didn't want them to have to have to bear witness to, they did, in extreme and almost unbelievable ways.

As a doula, I felt devastated for this couple. As a mentor, I felt terrible. I wanted so much to have everything be good. I didn't feel as responsible for what happened to the couple, as things were entirely out of our control. We know as doulas that we can't wave our magic wands, turn back time, and make the staff be nice. We can only deal gracefully and help the couple stay focused on birth rather than anger in the moment. But I certainly do feel responsible for my student, as I took a risk in asking her along, knowing it might be hard on her emotionally. Well, this birth would have been hard on ANY student emotionally, especially if were your introduction to birth attending. But I had really really wanted it to be good for her in particular.

From what I can tell, my apprentice's presence added extra support to a difficult situation, which was great for the clients. And I think she's doing okay. I remain available to students who need to process their experiences. Sometimes it takes a while because they are all busy with their lives as I am with mine, or sometimes it just doesn't feel right yet, but at some point these things come up when they're ripe and ready, and we can go over them. Sometimes it takes a while to process things before we wish to talk them out. I did feel I had to very quickly address the violence that we were exposed to.

I know this is going to sound deeply weird, but I had a dream recently in which I was on this bright, clear rocky mountain, very high up. A man dressed in dark furs leather coverings of a culture I can't identify said to me, "This is for you," and handed me a reddish brown stone with black stripes through it. He talked to me about how the masculine principle in birth is really important, that the practice of modern medicine (the gender of the practitioner doesn't matter...the energy of diagnosing and applying strong interventions being "masculine"), has in many ways improved lives for families over time. It is as "inspired" as any other healing modality. But the problem is that this masculine principle often ends up being the last word, usurping more feminine, intuitive, experiential wisdom instead of supporting and working in cooperation with it. It has made things out of balance and now many are harmed. The unpredictability of birth doesn't lend well to the sensibilities of Medicine, and there are often a lot of attempts to control the process. In order to gain control because of this trepidation towards the unknown, coercion can be used to manipulate certain situations. I was told to remember that it wasn't out of cruelty as it would outwardly seem, but out of extreme fear and vulnerability. This dream wasn't spoken in so many words, but this was the "message" I received loud and clear.

I had to write it down quickly after it happened to make sure I got it all, as these kinds of dreams, for those of you who dream this way know, are precious and often feel like they resonate with an incontrovertible truth that is not to be forgotten.

I had the image of the stone placed in my hand really strongly, so as soon as I could, I looked for images of it on the Internet and found it was red tiger eye. When looking at the symbolism behind this stone, I found it is used to "protect against abuses of power". I told my husband about my dream, and bless him, he goes along with me. He found some red tiger eye and gave it to me.

I took one of my stones (Hi, my name is Lesley, and yes, I keep stones meaningful to me in my birth bag...wanna make something of it? ;p) and gave it to my apprentice the next time I saw her. I explained it was a kind of amulet to protect her from the abuses of power she may witness in birth. When we had a moment alone, I briefly explained my dream (risking being gaped at as if I were insane). I also feel (yeah, laugh away) that something in that stone, or perhaps more accurately in the energy created by the connection to it through the dreaming and the giving of it, could begin to create a subtle shift towards healing. Sometimes less words are better and a gesture from the heart says much more.

It IS a risk to the hearts of students to bring them to births that might be hard. In the end, it's probably better that this incident happened while I was there... because it certainly won't be the last time she sees something like that. She saw a senior doula NOT lose her shit and go postal on the staff member (as much as it might have felt good to do so in the moment). She learned how to calm herself and take measures for herself so SHE didn't lose her shit and go postal. She learned how to shift gears fast, help clients rechannel their strong feelings to focus on love for their baby, and how to recognize the healing in subtle acts of compassion by other staff members who were also hurt by the witnessing. She learned how one is NEVER truly helpless, and that when all else seems hopeless, we have our ability to energetically broadcast peace. When we can't make peace, we can be it. This act holds more power than you may think.

When we sign up to be doulas, we take on the role knowing we will, at some point, get hurt. Yet even upon the hurting, we come back and risk again. It is a risk to me (my credibility, perception of my sanity, etc.)to share dreams and beliefs of such a personal nature with others. Nobody likes being judged. But like our ladies who risk their hearts by opening to the unpredictability of birth, the VAST majority of the time, the reward is immeasurable, and the healing intention is accomplished by getting down dirty real.

My apprentice accepted her tiger's eye with a genuine smile. I'm still not sure why I felt so strongly about bringing her to this birth, and maybe I'll never know. Sometimes it's just a mystery and we have to trust it's all getting worked out somewhere. I get a strong sense she's going to be just fine, though. Not because of the stone, obviously, or my kooky dream (though I hope it it helps), but because she's a strong, resiliant woman. She seems eager to go to more births, and that's a great thing. She's going to be a fine doula. Love and honour, Sister.

Wednesday, February 8, 2012

Don't be a "Do-la"

One of my teachers on my path of studying body/mind integration therapies had this great saying: "The more you do, the more you doo doo." Translation: the more you mess around with techniques "just because" instead of listening to the recipient of the work, making gentle suggestions with your hands, voice, tools, or energetic intention (IF warranted), the more you interfere with the body's impetus to self-healing. Obviously, there are times when big guns need to be called upon in our work as doulas, like hip presses and frequent positional changes, bodywork or remedies, even sometimes a little tough love. But as the intense birth energy works through the mother to open her up and bring forth her child, our job is ultimately to support, not meddle in what is normally an already pretty perfect process.

Many doulas these days introduce themselves to me or others with their catalogue of credentials, CEUs, certifications, and qualifications. The "with whoms" and "how many hours" and "advanced studies" all seem very important, and are listed in CV style on personal websites. Now there is NOTHING wrong with constant learning. I do it myself. But at some point, clients really don't care what you studied. Their eyes will glaze over after you've listed the third workshop or so. They are not concerned with a piece of paper (at least the hundreds of couples I've worked with aren't...rarely have I been even asked about my certifications, CEUs, advanced training, or association memberships). They want you to make them feel safe and can usually tell by meeting you if you "click" with them or not. Their feelings towards you will usually matter more than your impressive CV.

Many apprentices I work with and very new doulas I know, still years away from getting to tons of the great educational opportunities out there, are able to exude an energy of safety and calm that is palpable in the birthing room. Many a time I have seen doctors and nurses walk in and literally say, "It FEELS really good in here. I'm just going to sit down for a while." And they do, vibing out with the doulas for a spell. While the tools we learn from more experienced birth practitioners ARE immensely valuable, these are not necessarily the keys to becoming better doulas. More knowledgeable, and more skilled, yes. But not necessarily better. For you doulas out there who maybe see all of these opportunities online to attend amazing workshops and conferences but are unable to attend due to having young children or a lack of financial wherewithal, please don't despair. Being a doula is about a life time of learning. Until you are able to enrich your hands on skills through continuing education, if you are able to doula with presence,awareness, and most of all love, this is absolutely good enough. As far as I'm concerned, this is a grassroots, ancient, woman to woman role (a profession too, but more a role) which, if you are called from a deep place within to do, you will know very intuitively how to do it without a lot of bells and whistles. Women have been providing this support for each other from the beginning of time, so I figure the ancestral memories of how to do it are easily activated for those who feel that inexorable pull.

Often times, the more tools one has at one's disposal, the more one is apt to want to bust them out willy nilly if one's powers of discernment are still developing. I hear great explanations of the chosen tools/methods that are being applied to any given scenario, because it is exciting to speak of what we've learned...but perhaps not while the mom is busy trying to work her baby down and couldn't possibly be paying much attention.

My rule of thumb as a doula is to take the birthing mom's lead. It is easy to read someone's needs during labour. For example, some are chatty, and feel more grounded when you respond with a matched energy. You can see the labour progress and watch her fade away eventually into labour land. It is fun to have a conversation, then a conversation where concentration to keep talking through the contractions is necessary, then having the conversation between contractions, then having the train of thought forgotten entirely as the mother shifts into dream time. This is not talking randomly, it is actively using words appropriately as a method of relaxation. In fact, this woman left in what we think should be silence might actually feel more frightened or abandoned. Other women, however, would be in labour for days if you kept talking, so they would require near silence and perhaps a lot of touch communication. Some want you outside the room keeping unwanted visitors out of the space (cue lock and load sound), their need for your presence as great, just more with a focus on you containing their experience instead of mingling with it. Understanding how and when to apply the tools you have is far more important than having a ton of tools and not having appropriate discernment.

When a student or another doula I may be working with comes in with a massive amount of tools in her doula bag, claps her hands together and says, "Okay, let's get this baby out!" identifying where the squatting bars and birth balls are (before even really tuning in), I groan inwardly. It is an almost clinical approach, and I know we'll be in for a long haul much of the time. If, in being so excited about all the stuff you know that you start engaging the labouring mother's intellect and lecturing about why the double hip squeeze you're doing works, or say more than a sentence about why you're tucking a rebozo under her tummy and shaking her around, you may be impeding the labour process for that particular woman. Honestly, the mother doesn't give a whit about why if things are really active, she just wants sweet relief and is open to ideas you think may help her if she feels scared or flagging. That's what she hired you for, not to give her a crash course on labour support tools.

A doula should never be dependent upon her doula bag of tricks to help her during a birth. There are times you'll have to dash from somewhere that's not home without your stuff, and it shouldn't worry you at all. Your most important tools are your hands, your voice, your insight, your communication skills, and ultimately, your heart. The rest is just icing on the cake.

While accumulating a lot of knowledge and tools is a great and worthy endeavour , as you never know what could potentially help a birth that is experiencing a situation where a piece of knowledge or obscure skill could become invaluable, that list of creds isn't what makes the doula. It isn't what you DO a lot of the time, it is who you are. What you are DO-ing may be the simplest thing ever on a physical level, such as holding a hand or wiping away post vomit tears. But the energy you exude and the quality of space you hold is paramount. If you are distracted, inappropriately chatty, digging around for this and that in your bag "just because", flipping though your doula manuals to review procedures, shifting around and bustling, you are probably doing too much. If you sit, stand, or hold with awareness, with presence, "listening" to the environment and working with the feel (energy) of the room actively but quietly, this may some of your most effective doula-ing. And this will be confirmed to you. I recently had a lady having her third baby. She had had epidurals for her first two and wanted to have a natural birth this time. I sat in a chair by her bed. Yup, that's what I did. The whole labour. That is what felt right. I sat and beheld, quietly synching my breathing with hers, relaxing my shoulders when I saw her raising hers, loosening my jaw when I saw hers clench. She told me afterwards she couldn't have done it without me, and I reassured her that I did absolutely nothing, that she did all the work and was blessed to have had a nearly pain free birth. She said, "But you weren't just sitting there. I could feel waves of absolute calm and trust coming from you. I felt your connection to me unwavering, and it made me unafraid." Remember, labouring ladies are deeply attuned. A touch that has no heart in it will often be noticed and not appreciated. Zoning out because "there's nothing to do" makes some feel abandoned. Keep checking in.

In the doula training I provide, we certainly go over a whole bunch of nifty tools gleaned from almost two decades on the job, but those are only stepping stones. I prefer to focus on the quality of presence a doula holds for her clients. How do you listen? How do you tune in? How do you hold the space? How do you channel calm into a stressful environment? What may you need to work on within yourself to have more access to insight and intuition? What can you broadcast energetically to bring a positive change to a situation? This is doula-ing in the deepest sense of the word "holistic".

There is a BEAUTIFUL scene in the British series "Call the Midwife" which illustrates the essence of what I'm talking about. A clumsy new midwife named "Chummy" who has barely passed her qualifying exams experiences her first professional clinic day. An obstetrician has been called to this clinic (run by nuns) in London's East End (circa 1950's) to assess a case of a woman whose pelvis has been deformed by rickets. She has lost four previous babies at term due to severely obstructed labours. Now with the National Health Services, she gets the opportunity to have a Cesarean this time, and the only shot at having a live baby. The doctor is explaining the woman's rickety pelvis to Chummy, going over all this technical stuff, looking at his x-rays, not tuned in at all to the fact that this mother is looking terrified and grieving. He is very excited about the opportunity this poverty stricken woman gets to birth by Cesarean at a hospital and is kind of carried away with the details. He's a lovely man, he is just doing his clinical job and is not at the moment "tuned in". Chummy very clearly is, and has her eyes on the lady the entire time. You can just feel the solid, grounded compassion she starts exuding as she keeps eye contact. The mother bursts into tears over her lost babies, apologizing for her emotional state. The doctor looks uncomfortable and sheepish about the tears. Chummy takes her hand and gets close, and weaves a web of calm and safety around her, honouring her experience and her emotions. She explains how wonderfully safe this mother is in this excellent doctor's hands, that this is a new baby and new experience, and that everything is going to be okay. For all her lumbering ways and technical shortcomings, there is authority in her emotional presence. The doctor takes her aside and tells her that she is a WONDERFUL nurse midwife, because she has provided one of the most valuable things to her patient, which is a sense of safety and trust.

In my humble opinion, THAT type of doula skill is the most important to develop...excellent touch, verbal, and energetic communication and environment monitoring. And you don't even have to write it on your CV!

Doctors, nurses, and midwives are often reminding themselves to "sit on their hands" to allow the birth process to unfold optimally without unnecessary intervention. Doulas must be careful of this too. Remember, we are not "Do-las", which entails bustling around all efficiently, spouting our street creds, getting the job done with an agenda, and owning "successes", but "Doulas", who inform, nurture, honour,and support in the unique way each situation calls for...with presence, insight, grace, and love.