In a world where the goal of SuperMom reigns supreme, tender new mothers are often left feeling overwhelmed by the expectations they have of themselves. Women often feel if they are not actively managing their post baby weight, contributing to the family financially, keeping a clean orderly home, creating meals, tending to all the physical and emotional needs of all family members, being an attentive friend with a social life, enjoying sexual relations with her partner, succeeding at having her baby trained to sleep most of the night, and with a wealth of energy to complete even some of these tasks immediately postpartum, they are not succeeding as the mothers they hoped they'd be.
The reality looks more like this: a new mama is TIRED. Breastfeeding sometimes has a few glitches that take a little while to work out. She is often left feeling quite tender physically and emotionally after the birth experience. Just getting enough to eat and finding the time to nap to make up for those all night nursing marathons are challenges. The reality sets in after a few days home with Baby that she can either shower OR do the dishes in a day....probably not both. For a woman used to being a multi-tasking, high-achieving dynamo, feeling exhausted, tearful, confused, spit-up stained and leaky-breasted can be quite a shock, no matter what all the books say.
In days of old, we used to live tribally or in close contact with extended family. The home and hearth would be tended to by other members of the family community, and new mothers would be able to focus on healing after birth. Most importantly, they would have ample time to fall in love with and bond with their new babies, receiving experienced, wise guidance from other women in the tribe about breastfeeding and baby care. The new mother would grow solidly into her role without being overwhelmed by needs beyond hers and her baby's, and her confidence would blossom in the light of the loving support of her elders. In some traditional cultures, mothers are sequestered for about 40 days after birth skin to skin with their babies, receiving daily massages and being fed special foods prepared by other women. Contrast this image to our expectations of SuperMom, and we can begin to understand why the postpartum experience is often feared, and high rates of depression reported.
I would like to introduce you to the important, beautiful work of the postpartum doula. A postpartum doula is a woman who is experienced in supporting mothers in the days and weeks following the birth of a baby. It is a role which is very simple in its intent: to ensure a new mother has what she needs to feel good about motherhood, and to help build confidence in her mothering skills. How does the postpartum doula achieve this? By giving Mom freedom to focus on bonding with her baby and family. To achieve this goal, a postpartum doula's skills are many and varied. She provides knowledgeable breastfeeding support, usually encouraging breastfeeding on demand and helping with basic breastfeeding challenges. She answers general baby care questions. Nutritional support is provided by doing some cooking of wholesome meals and snacks for the family. Organizing and light cleaning can help take some of the strain off Mom so she has an orderly environment within which to hang out with her baby. The postpartum doula can integrate siblings into sharing in the care of the newborn, and she can care for them while Mom naps with Baby.
The mother's partner and other adult family members, such as grandmas and aunties, greatly benefit from a postpartum doula's care as well. They learn, through the doula's example, how to confidently physically and emotionally support the mother's unique needs. They learn evidence based information about breastfeeding and baby care, and also get time to rest and bond with Baby when other basic needs are met. Very often, the other parent is also overwhelmed by the needs of a freshly birthed mother and baby. As sleep deprived new dads/moms, they are often still expected to provide financially, do some of the household tasks and cooking, care for other children, and weather the ups and downs of the emotional landscape of new parenthood. A postpartum doula ensures partners also feel cared for, which allows them more time and energy just to relax with their partner and forge their own relationship with Baby.
A postpartum doula nurtures the new parents with her loving, wise presence. While she may bring food, wear the baby in a carrier or sling, and do some laundry while the parents nap, provide breastfeeding support, gently guide visitors to limit their time when she notices Mom is getting tired, and help parents sort out what information is good for them and what isn't, the postpartum doula is primarily someone who listens. She can hear the deeper concerns behind questions, and provide a non-judgemental space within which parents can process their experience. She helps sort out feelings surrounding a difficult birth experience. She reassures the emotional ups and downs are normal, and can help to guide parents to appropriate resources when things veer outside of that range. She is a wealth of resourceful information, able to help the couple choose products that are appropriate for their lifestyles, help them find parenting groups to alleviate the sense of isolation new parents sometimes experience, and can guide them to a myriad of professional resources.
It is important to note that a pospartum doula is not a Baby nurse. A doula cannot “diagnose” or “treat” anything, nor provide any medical advice about a mother's or baby's health. In her experience, however, she can gage when something is a concern, and guide the parents to the proper resources to get things checked out. She can, however, use safe, holistic remedies to help with the basic challenges of breatfeeding and postpartum recovery, such as recommend warm compresses and cabbage leaves for engorged breasts, sitz baths for perineal tears, or massage for “new parent neck”.
Millie Tresierra, Senior Postpartum Doula of MotherWit Doula Care in Montreal, has been a parent/baby supporter for many years. She says, “Rest and nutrition are the two vehicles that will carry Mom and Baby through the first few months together. Everything else will fall into place around these two things.” Her job is to ensure the integrity of these vehicles, and says sometimes she literally tucks the whole family into bed for a few hours while she tidies, encouraging them that emails and phone calls to enthusiastic family and friends can wait. She likens her doula work to holding a little boat (the family unit) tenderly in her hands, supporting it as it learns to navigate the unpredictable waters. Little by little, she releases her hands until that boat learns how to weather the changes in the waters with confidence, and is able to float all on its own.
Typically, Millie meets couples before the birth of the baby to learn what is important to them. What do they like to eat? What makes them feel rested? What are their parenting ideas? What challenges may they have with visitors and unsolicited advice from well meaning friends? What are their fears and concerns? She outlines a schedule that will suit the couple, and then she'll wait for their phone call informing her that the baby or, in the cases of multiples, the babies are born and that it's time for her to get to work and settle the parents into their new and exciting journey.
If a mom admits, “You know, I wouldn't tell this to just anyone, but all my partner and I want to do is sit here and stare at our baby for hours and block the rest of the world out for awhile. Is this normal?” you will most likely hear a postpartum doula respond, “Honey, that is music to my ears.”
Monday, June 14, 2010
Thursday, June 3, 2010
Patient Interest or Witch Hunt?
I had a lovely birth at St. Mary's Hospital early this morning. This baby was truly a miracle in many senses of the word, and it was an amazing honour to support such a powerful, triumphant experience. To know I am a positive part of this precious memory of birth is the deep reward for being a doula.
After the baby arrived safely, the nurse, whom everyone enjoyed as a strong, supportive, incredibly experienced presence, asked me to leave my name at the nurse's desk. I admit it was about 2:30am and my faculties of information retention may not have been at their best, but what I understood was that people who were coming into St. Mary's as doulas needed to register their names. This was news to me. It is true that St. Mary's is not the hospital I work most frequently at, perhaps only attending 10 births a year or so there, but I had not heard of this request before, neither personally nor from my doula colleagues.
I jokingly asked the nurse if I was about to be blacklisted, or if alarms and whistles would go off if I walked into Saint. Mary's again. She said they had a new policy to know who doulas were, because they were no longer allowing "medical management" of birth to be conducted by doulas. I said, "But doulas aren't qualified or allowed to manage anything medically!" Her expression was kind, but made it clear that the phenomenon of doulas behaving badly was alive and well at her place of work.
On the one hand, I most certainly do agree that medical staff should not have to feel medically challenged by a person who is supposed to be providing emotional support and comfort measures for their clients. This is not safe for anyone. I feel very badly for the staff who work extremely hard, have protocols that are part of their job description to follow, have the weight of immense responsibility for the well being of a mother and child on their shoulders, then have to deal with a naysayer in the room whose modes of advocacy are combative, and therefore unwise. If a doula's attitude is negative towards the staff, breeding mistrust in her clients for these caregivers, leading them towards choices based on her personal agenda rather than helping them make informed decisions in light of what the staff deems medically necessary for their care, then yes...it makes sense the staff would want to know about this person and set limits on behaviours that interfere with their responsibilities.
But on the other hand....
My name was taken down not on any official form that would reflect this was an established hospital policy, but on a scrap of paper. No phone number, email address, feedback, nothing. Just my name on a little square of paper. Now I wonder what will happen to my name. Will I be Googled? Will they talk about me in the nurse's station? Will they grill my clients on their level of satisfaction with my services? Will they pick through all my behaviours that were annoying to them, blow them up into monstrous proportions, and then put me on the black list so that when I next walk through the doors of St. Mary's I will be met with the stink eye by everyone? I have to say, I am concerned.
Of course, my first thought was to go over my behaviour. It is always very important as a doula to constantly review where we can improve. My clients seemed to be very happy with my services, as I helped them to have the un-epiduraled birth they were dreaming of. So how did I do this?
1) My client had to have an I.V. for medical reasons, so I asked the nurse (not the same one who took my name) if a saline lock could be put in so she could walk around. Remember, I spend a lot of time with my clients prenatally, and get to know what would help them, given their personalities and concerns, cope with the challenges of labour. There was no doubt this lady needed to move a lot of energy by walking. The nurse said this would be no problem. It wasn't offered as an option, but upon my asking, it was kindly given. So walk my client did...with more energy that I had, not to mention a few trips up and down stairs, which would have been impossible with an I.V. pole. The monitoring devices were wireless, which allowed for free movement, so it only made sense that not having to march around with a heavy I.V. pole if not medically necessary at that time would make my client more comfortable. St. Mary's is a hospital which embraces the Baby Friendly Initiative, and I figure empowered birth must be an aspect of that initiative, given there are textbooks on the subject of the impact of unnecessary medical interventions on breastfeeding.
2)My client wanted to avoid labour stimulation. Due to existing circumstances, getting labour going was an important goal, so I used lots of acupressure and aromatherapy, which really seemed to help pick up contractions. Eventually, some synthetic oxytocin was ordered by her doctor, and I in no way got in the way of the staff doing what they had to do in that regard. That is beyond my scope of practice. The stimulation was absolutely minimal, and resulted in an un-epiduraled, beautiful birth.
3)My client wanted to be free to be in whatever position she wanted, but when it came time to push, her doctor was not immediately available, and it looked like the nurse would be catching the baby. She put my client into the traditional position, and as my client didn't argue about it, I didn't feel like saying, "Hey, you said you wanted to be in another position...are you sure you want to be on your back?" would enhance the situation. I felt it was important for the nurse to be comfortable with what she was doing, as she was put in the position to be responsible for this situation. My instinct was just to be silent and to trust my client would speak up herself if the position was not good for her.
4) I could tell my client was NOT liking the yelling at her to make no noise during pushing. She was vocalizing powerfully, and her baby was moving down. In fact, the baby moved down and out in 12 minutes, most of the time with her mom bellowing. I never direct pushing unless it's asked for by my client, or she is very scared to go into that downward sensation and a little encouragement to bear down to push some of the tension away would be helpful, or it is made known the baby truly needs to come out quickly and focused pushing is necessary. The reasons I try to remain quiet are 1) There are enough frighteningly loud voices in the room contributing to the Purple Pushing Party. 2)With a baby coming down that straightforwardly, it makes little sense to me to make a mom feel criticized for how her body is naturally and spontaneously expelling her baby. I have personal experience of pushing with no direction. I know if she were birthing unassisted accidentally somewhere, nobody would tell her when or how to push. It would just happen, and the VAST majority of the time Baby would simply emerge, Mom yelling or not yelling. I don't buy the argument that a woman will get more exhausted by the second stage being longer if she is doing what comes naturally as opposed to making it fast by expending eyeball popping effort. Yes, we know on average purple pushing makes the baby come 13 minutes faster, but evidence suggests to me, granted this being merely anecdotal evidence, as I'm the one who follows up with the mom postpartum at home, that she's in better shape when, if possible, she directs her own pushing.
Now it's important to note that while this is my personal opinion, I didn't state it out loud. There's no room for naysaying in a birth or ego centred battling over a client's body. I didn't request anyone stop directing. At some point my client looked at me at and indicated she was not enjoying being yelled at, that her vocalizations felt good to her, and I just winked at her and whispered that she was doing beautifully and that her wonderful efforts were making us see the baby already. Those words made her realize she was not actually doing anything wrong without criticizing anyone else in the room.
5)My client was interested in the baby latching on by herself by doing the breast crawl. St. Mary's is very supportive of constant skin to skin contact after birth, and it was a lovely, gentle environment for this new being in the world. Sadly, as the breast crawl often takes more than the hour or so the mother is left in the birthing room to recover before being transferred to postpartum, it is often unrealistic to be allowed to wait this amount of time. This sort of diminishes the Baby Friendly aspect a little, as the W.H.O. seems to very much support infant initiated latch. So if there isn't enough time to do it, then this crawl must be interrupted so the baby can at least get a suckle in before they have to be transported to postpartum. Not ideal, but as the beds are being waited for by labouring mothers in the hall a lot of time, C'est la vie. Baby was very alert and by being placed closer to the breast, she found it and latched on her own anyway, in a biologically nurturing position.
6)My client did not want drops in the baby's eyes until after feeding was initiated. The nurse was about to put them in the eyes and I asked what the window of time was, as every hospital seems to have a different policy on this. The nurse said it has to be done right away when there is GBS. I didn't argue, as this was again not a huge issue to begin discussing, but I have had doctors tell me the drops don't affect GBS, that they are only really for possible STIs. It is difficult to know what to do when the information I receive from various sources is often conflicting, and as the parents at the time weren't too worried about it, I let it go. Parents in the end want to remember peaceful contact with their newborn, not battling opinions.
7) In postpartum, when the baby was about to get the vitamin K shot, I asked if she could be at the breast while she was receiving it. This was not offered as an option, but was happily provided upon asking. The parents were very glad for this arrangement, as suckling releases endorphins and calms the newborn, thus reducing some of the pain of the injection.
All this is to say is that I feel I walked the line appropriately of advocating for my clients' wishes in a positive, friendly way, and not getting in the way of staff members trying to do their jobs.
Taking down my name on a piece of scrap paper makes me feel scrutinized. I am not worried that I did anything to endanger my client's or her baby's health, but what does worry me are the implications of this "policy".
All of the staff I worked with were kind and respectful of my clients' experience to the best of their knowledge and ability. They were kind and respectful of me too. But what if a doula coming into St. Mary's is just doing her job the same way, but for some reason her personality or approach rubs a nurse the wrong way that day, even if she's not actually doing anything inappropriate? What if a nurse is particularly sensitive to perceiving criticism when a doula is supporting her client a certain way and the client is more responsive to the doula's support than the nurse's, and the nurse gets upset? What if the staff believes the requests and "rebellion" of the couple are being generated by the doula herself? Remember, just because a patient is challenging doesn't mean the doula should be made scapegoat. If a client squats on the floor and starts birthing, or pulls out her IV, or refuses to get on her back, it doesn't mean we've guided her to do so.
I don't believe for a second many of us are as bad as we're made out to be as a group. Yes, there are undeniably a few bad bananas in every bunch, as there are in hospitals. This doesn't mean each doula should be demonized for every little inconvenience that comes up for the staff, or be judged unfairly because the last doula who was at the hospital happened to be a nightmare and everyone's still reeling from that experience.
The bottom line is the role of doula is bequeathed to us by the parents themselves. They understand the hospital system can be big, unfamiliar, overwhelming, and with unpredictable service. We don't come storming in bringing our clients with us to prove a point. We are there because your patients hired us privately to be there, knowing that in labour they may be too vulnerable, occupied, or unaware of what their options are to achieve their greatest comfort. Yes, that is a criticism of your system. But you know it yourselves. Don't blame the doula and project onto us your judgement that we embody this criticism, are there to make your lives miserable, and to make our clients our own personal political projects. A good doula wants to bridge the gap between the solid clinical care and technology you provide, and continuous one on one support and advocacy, which, sorry to say, means we will ask questions in order to facilitate the best experience we can for our clients. I will not do this in a way to make you feel that your patients are endangered. I respect your knowledge and experience. I will honour your medical choices, but I will at times, if it is appropriate to the situation of my client, question the evidence of some traditions and statements, and request things that may not always be the most convenient for you, like saline locks and intermittent monitoring while a client sits on a ball instead of lies on a bed. You may notice me being very different from one client to another. This is because we advocate the CLIENT'S wishes, not mine, and all clients have different needs and wishes.
My career and livelihood depends upon my being allowed into the hospital system. This is not just some little hobby of mine. I have spent almost 19 years developing myself and my skill set to be a doula to the best of my ability. To become blacklisted because someone's ego was bruised one day, or because someone misinterpreted my question for my client's sake as a personal attack, or if my client locked herself in the bathroom and gave birth without my having any clue she was going to do that, crosses the line between claiming safety for patients, and a blatant witch hunt.
Doulas, I think it is really important when you go to St. Mary's Hospital to ask to officially see this policy on paper, and to have everything explained to you before you give your name. I was very busy, and didn't manage to do this. My sense and fear is that even if you work within the scope of doula practice, doing your best to be as nice to everyone as possible, you might be misinterpreted, someone might get mad at you, and poof, there goes your ability to work at St. Mary's. Not to condemn a hospital staff as a whole, but there might be some people who will dislike you immediately simply because you ARE a doula, and will interpret every question, word, and action as a criticism or threat. I have seen this. It is certainly not the norm, as I find the vast majority of people give us the benefit of the doubt if they don't know us. But what if you get unlucky? I want this policy to be extremely clear, out in the open, publicized, doulas made aware of it immediately when they arrive, AND I want some assurance that our practices are protected from those who are unequivocally anti-doula. St. Mary's wants to be protected from doulas who are anti-hospital, and I understand this, but it needs to be a two way street. Whether or not our presence is appreciated by hospital staff, our popularity still grows, good birth outcome stats still rise with our presence, parents still love us, so, friends, we ain't going anywhere. My spidey senses tell me clarity and forthrightness about this new policy needs to happen before gradually all of us doulas who work tirelessly to create a legacy of gentle, lovely, humane hospital birth are, so to speak, burned at the stake.
After the baby arrived safely, the nurse, whom everyone enjoyed as a strong, supportive, incredibly experienced presence, asked me to leave my name at the nurse's desk. I admit it was about 2:30am and my faculties of information retention may not have been at their best, but what I understood was that people who were coming into St. Mary's as doulas needed to register their names. This was news to me. It is true that St. Mary's is not the hospital I work most frequently at, perhaps only attending 10 births a year or so there, but I had not heard of this request before, neither personally nor from my doula colleagues.
I jokingly asked the nurse if I was about to be blacklisted, or if alarms and whistles would go off if I walked into Saint. Mary's again. She said they had a new policy to know who doulas were, because they were no longer allowing "medical management" of birth to be conducted by doulas. I said, "But doulas aren't qualified or allowed to manage anything medically!" Her expression was kind, but made it clear that the phenomenon of doulas behaving badly was alive and well at her place of work.
On the one hand, I most certainly do agree that medical staff should not have to feel medically challenged by a person who is supposed to be providing emotional support and comfort measures for their clients. This is not safe for anyone. I feel very badly for the staff who work extremely hard, have protocols that are part of their job description to follow, have the weight of immense responsibility for the well being of a mother and child on their shoulders, then have to deal with a naysayer in the room whose modes of advocacy are combative, and therefore unwise. If a doula's attitude is negative towards the staff, breeding mistrust in her clients for these caregivers, leading them towards choices based on her personal agenda rather than helping them make informed decisions in light of what the staff deems medically necessary for their care, then yes...it makes sense the staff would want to know about this person and set limits on behaviours that interfere with their responsibilities.
But on the other hand....
My name was taken down not on any official form that would reflect this was an established hospital policy, but on a scrap of paper. No phone number, email address, feedback, nothing. Just my name on a little square of paper. Now I wonder what will happen to my name. Will I be Googled? Will they talk about me in the nurse's station? Will they grill my clients on their level of satisfaction with my services? Will they pick through all my behaviours that were annoying to them, blow them up into monstrous proportions, and then put me on the black list so that when I next walk through the doors of St. Mary's I will be met with the stink eye by everyone? I have to say, I am concerned.
Of course, my first thought was to go over my behaviour. It is always very important as a doula to constantly review where we can improve. My clients seemed to be very happy with my services, as I helped them to have the un-epiduraled birth they were dreaming of. So how did I do this?
1) My client had to have an I.V. for medical reasons, so I asked the nurse (not the same one who took my name) if a saline lock could be put in so she could walk around. Remember, I spend a lot of time with my clients prenatally, and get to know what would help them, given their personalities and concerns, cope with the challenges of labour. There was no doubt this lady needed to move a lot of energy by walking. The nurse said this would be no problem. It wasn't offered as an option, but upon my asking, it was kindly given. So walk my client did...with more energy that I had, not to mention a few trips up and down stairs, which would have been impossible with an I.V. pole. The monitoring devices were wireless, which allowed for free movement, so it only made sense that not having to march around with a heavy I.V. pole if not medically necessary at that time would make my client more comfortable. St. Mary's is a hospital which embraces the Baby Friendly Initiative, and I figure empowered birth must be an aspect of that initiative, given there are textbooks on the subject of the impact of unnecessary medical interventions on breastfeeding.
2)My client wanted to avoid labour stimulation. Due to existing circumstances, getting labour going was an important goal, so I used lots of acupressure and aromatherapy, which really seemed to help pick up contractions. Eventually, some synthetic oxytocin was ordered by her doctor, and I in no way got in the way of the staff doing what they had to do in that regard. That is beyond my scope of practice. The stimulation was absolutely minimal, and resulted in an un-epiduraled, beautiful birth.
3)My client wanted to be free to be in whatever position she wanted, but when it came time to push, her doctor was not immediately available, and it looked like the nurse would be catching the baby. She put my client into the traditional position, and as my client didn't argue about it, I didn't feel like saying, "Hey, you said you wanted to be in another position...are you sure you want to be on your back?" would enhance the situation. I felt it was important for the nurse to be comfortable with what she was doing, as she was put in the position to be responsible for this situation. My instinct was just to be silent and to trust my client would speak up herself if the position was not good for her.
4) I could tell my client was NOT liking the yelling at her to make no noise during pushing. She was vocalizing powerfully, and her baby was moving down. In fact, the baby moved down and out in 12 minutes, most of the time with her mom bellowing. I never direct pushing unless it's asked for by my client, or she is very scared to go into that downward sensation and a little encouragement to bear down to push some of the tension away would be helpful, or it is made known the baby truly needs to come out quickly and focused pushing is necessary. The reasons I try to remain quiet are 1) There are enough frighteningly loud voices in the room contributing to the Purple Pushing Party. 2)With a baby coming down that straightforwardly, it makes little sense to me to make a mom feel criticized for how her body is naturally and spontaneously expelling her baby. I have personal experience of pushing with no direction. I know if she were birthing unassisted accidentally somewhere, nobody would tell her when or how to push. It would just happen, and the VAST majority of the time Baby would simply emerge, Mom yelling or not yelling. I don't buy the argument that a woman will get more exhausted by the second stage being longer if she is doing what comes naturally as opposed to making it fast by expending eyeball popping effort. Yes, we know on average purple pushing makes the baby come 13 minutes faster, but evidence suggests to me, granted this being merely anecdotal evidence, as I'm the one who follows up with the mom postpartum at home, that she's in better shape when, if possible, she directs her own pushing.
Now it's important to note that while this is my personal opinion, I didn't state it out loud. There's no room for naysaying in a birth or ego centred battling over a client's body. I didn't request anyone stop directing. At some point my client looked at me at and indicated she was not enjoying being yelled at, that her vocalizations felt good to her, and I just winked at her and whispered that she was doing beautifully and that her wonderful efforts were making us see the baby already. Those words made her realize she was not actually doing anything wrong without criticizing anyone else in the room.
5)My client was interested in the baby latching on by herself by doing the breast crawl. St. Mary's is very supportive of constant skin to skin contact after birth, and it was a lovely, gentle environment for this new being in the world. Sadly, as the breast crawl often takes more than the hour or so the mother is left in the birthing room to recover before being transferred to postpartum, it is often unrealistic to be allowed to wait this amount of time. This sort of diminishes the Baby Friendly aspect a little, as the W.H.O. seems to very much support infant initiated latch. So if there isn't enough time to do it, then this crawl must be interrupted so the baby can at least get a suckle in before they have to be transported to postpartum. Not ideal, but as the beds are being waited for by labouring mothers in the hall a lot of time, C'est la vie. Baby was very alert and by being placed closer to the breast, she found it and latched on her own anyway, in a biologically nurturing position.
6)My client did not want drops in the baby's eyes until after feeding was initiated. The nurse was about to put them in the eyes and I asked what the window of time was, as every hospital seems to have a different policy on this. The nurse said it has to be done right away when there is GBS. I didn't argue, as this was again not a huge issue to begin discussing, but I have had doctors tell me the drops don't affect GBS, that they are only really for possible STIs. It is difficult to know what to do when the information I receive from various sources is often conflicting, and as the parents at the time weren't too worried about it, I let it go. Parents in the end want to remember peaceful contact with their newborn, not battling opinions.
7) In postpartum, when the baby was about to get the vitamin K shot, I asked if she could be at the breast while she was receiving it. This was not offered as an option, but was happily provided upon asking. The parents were very glad for this arrangement, as suckling releases endorphins and calms the newborn, thus reducing some of the pain of the injection.
All this is to say is that I feel I walked the line appropriately of advocating for my clients' wishes in a positive, friendly way, and not getting in the way of staff members trying to do their jobs.
Taking down my name on a piece of scrap paper makes me feel scrutinized. I am not worried that I did anything to endanger my client's or her baby's health, but what does worry me are the implications of this "policy".
All of the staff I worked with were kind and respectful of my clients' experience to the best of their knowledge and ability. They were kind and respectful of me too. But what if a doula coming into St. Mary's is just doing her job the same way, but for some reason her personality or approach rubs a nurse the wrong way that day, even if she's not actually doing anything inappropriate? What if a nurse is particularly sensitive to perceiving criticism when a doula is supporting her client a certain way and the client is more responsive to the doula's support than the nurse's, and the nurse gets upset? What if the staff believes the requests and "rebellion" of the couple are being generated by the doula herself? Remember, just because a patient is challenging doesn't mean the doula should be made scapegoat. If a client squats on the floor and starts birthing, or pulls out her IV, or refuses to get on her back, it doesn't mean we've guided her to do so.
I don't believe for a second many of us are as bad as we're made out to be as a group. Yes, there are undeniably a few bad bananas in every bunch, as there are in hospitals. This doesn't mean each doula should be demonized for every little inconvenience that comes up for the staff, or be judged unfairly because the last doula who was at the hospital happened to be a nightmare and everyone's still reeling from that experience.
The bottom line is the role of doula is bequeathed to us by the parents themselves. They understand the hospital system can be big, unfamiliar, overwhelming, and with unpredictable service. We don't come storming in bringing our clients with us to prove a point. We are there because your patients hired us privately to be there, knowing that in labour they may be too vulnerable, occupied, or unaware of what their options are to achieve their greatest comfort. Yes, that is a criticism of your system. But you know it yourselves. Don't blame the doula and project onto us your judgement that we embody this criticism, are there to make your lives miserable, and to make our clients our own personal political projects. A good doula wants to bridge the gap between the solid clinical care and technology you provide, and continuous one on one support and advocacy, which, sorry to say, means we will ask questions in order to facilitate the best experience we can for our clients. I will not do this in a way to make you feel that your patients are endangered. I respect your knowledge and experience. I will honour your medical choices, but I will at times, if it is appropriate to the situation of my client, question the evidence of some traditions and statements, and request things that may not always be the most convenient for you, like saline locks and intermittent monitoring while a client sits on a ball instead of lies on a bed. You may notice me being very different from one client to another. This is because we advocate the CLIENT'S wishes, not mine, and all clients have different needs and wishes.
My career and livelihood depends upon my being allowed into the hospital system. This is not just some little hobby of mine. I have spent almost 19 years developing myself and my skill set to be a doula to the best of my ability. To become blacklisted because someone's ego was bruised one day, or because someone misinterpreted my question for my client's sake as a personal attack, or if my client locked herself in the bathroom and gave birth without my having any clue she was going to do that, crosses the line between claiming safety for patients, and a blatant witch hunt.
Doulas, I think it is really important when you go to St. Mary's Hospital to ask to officially see this policy on paper, and to have everything explained to you before you give your name. I was very busy, and didn't manage to do this. My sense and fear is that even if you work within the scope of doula practice, doing your best to be as nice to everyone as possible, you might be misinterpreted, someone might get mad at you, and poof, there goes your ability to work at St. Mary's. Not to condemn a hospital staff as a whole, but there might be some people who will dislike you immediately simply because you ARE a doula, and will interpret every question, word, and action as a criticism or threat. I have seen this. It is certainly not the norm, as I find the vast majority of people give us the benefit of the doubt if they don't know us. But what if you get unlucky? I want this policy to be extremely clear, out in the open, publicized, doulas made aware of it immediately when they arrive, AND I want some assurance that our practices are protected from those who are unequivocally anti-doula. St. Mary's wants to be protected from doulas who are anti-hospital, and I understand this, but it needs to be a two way street. Whether or not our presence is appreciated by hospital staff, our popularity still grows, good birth outcome stats still rise with our presence, parents still love us, so, friends, we ain't going anywhere. My spidey senses tell me clarity and forthrightness about this new policy needs to happen before gradually all of us doulas who work tirelessly to create a legacy of gentle, lovely, humane hospital birth are, so to speak, burned at the stake.
Thursday, May 27, 2010
Giving Kudos Where They're Due
I love to meet new doctors and residents in the hospitals I work at. Because the residents often spend time at different hospitals like I do, I get quite familiar with some of them.
On occasion you meet someone who is just born to attend women in birth. Within the last couple of months I have worked with an absolutely amazing young resident. Every client of mine who has spoken to him or been treated by him always says, "Wow, I like that guy!"
Many residents, getting grounded in their doctoring career, are focused really hard on gathering clinical skills, doing as many procedures as possible to get lots of experience. Obviously, this is really important. But sometimes it's to the point of forgetting that attached to this pelvis before them is a woman bringing life into the world. She is having a day she will never forget, a day that will shape her early motherhood. Residents sometimes lose sight of the fact they will be in many cases remembered forever, as the day of a child's birth is an incredibly important day in a family's life. A woman at the end of that day will usually grieve insensitive treatment, it being etched into her mind forever, more so at times than the clinical details of her birth. In their lovey/bondey oxytocin high, mothers will remember their caring attendants of the birth of their precious babies with genuine fondness. Forever.
Given all the crazy hard work residents do, I realize it can become easy to forget about contributing to more than just the clinical aspect of hospital birth. So what's great about my new resident buddy is that while he is gathering skill perfecting experience and working crazy hard too, he never forgets to be kind and respectful. If a woman is working to have an unmedicated birth, he absolutely honours that and doesn't offer any interventions, unless necessary, that could potentially throw a monkey wrench into that heartfelt dream of hers. He doesn't judge. He is curious about his patients' lives, and says things like, "The birthing woman is the Queen in the delivery room." If I say something he may not know about supporting natural birth and breastfeeding, he gets curious and doesn't brush me off as non-medical-therefore-irrelvant.
This is a doctor whom I trust and feel very pleased when I see him walking around the halls in the hospital. He has that skill of being able to click with just about anybody. I know my ladies will be in good hands and will not only have their clinical needs tended to, but their experiences enhanced by his presence.
A doula's 2 thumbs up to Dr. C!
I also want to give snaps to my spectacular sister Motherwitties Sesch and Molly for providing me with back-up when I had 2 ladies birthing at the same time and needed to leave the hospital to be with my son during his dental surgery. I was leaving them both with women having quite challenging labours, and they are always able to just go in there, adapt, and get to work in their unique, marvellous ways. I didn't worry about any of my clients at all in their good hands, and was able to tend to my little boy fully present for him, if not a little tired from having been up all night. I am so blessed to have a team of women I know love this work, and are deeply honouring of whatever a woman needs to feel supported and good about herself during her birth process.
Lastly, another Kudos to the great Montreal OB nurses who are the busiest ladies in town, yet manage to make their patients feel special and supported. Nurses, who have FAR more patient contact than doctors during birth and are often running around non stop their entire shifts, don't usually forget that they are part of a future memory, and act accordingly.
On occasion you meet someone who is just born to attend women in birth. Within the last couple of months I have worked with an absolutely amazing young resident. Every client of mine who has spoken to him or been treated by him always says, "Wow, I like that guy!"
Many residents, getting grounded in their doctoring career, are focused really hard on gathering clinical skills, doing as many procedures as possible to get lots of experience. Obviously, this is really important. But sometimes it's to the point of forgetting that attached to this pelvis before them is a woman bringing life into the world. She is having a day she will never forget, a day that will shape her early motherhood. Residents sometimes lose sight of the fact they will be in many cases remembered forever, as the day of a child's birth is an incredibly important day in a family's life. A woman at the end of that day will usually grieve insensitive treatment, it being etched into her mind forever, more so at times than the clinical details of her birth. In their lovey/bondey oxytocin high, mothers will remember their caring attendants of the birth of their precious babies with genuine fondness. Forever.
Given all the crazy hard work residents do, I realize it can become easy to forget about contributing to more than just the clinical aspect of hospital birth. So what's great about my new resident buddy is that while he is gathering skill perfecting experience and working crazy hard too, he never forgets to be kind and respectful. If a woman is working to have an unmedicated birth, he absolutely honours that and doesn't offer any interventions, unless necessary, that could potentially throw a monkey wrench into that heartfelt dream of hers. He doesn't judge. He is curious about his patients' lives, and says things like, "The birthing woman is the Queen in the delivery room." If I say something he may not know about supporting natural birth and breastfeeding, he gets curious and doesn't brush me off as non-medical-therefore-irrelvant.
This is a doctor whom I trust and feel very pleased when I see him walking around the halls in the hospital. He has that skill of being able to click with just about anybody. I know my ladies will be in good hands and will not only have their clinical needs tended to, but their experiences enhanced by his presence.
A doula's 2 thumbs up to Dr. C!
I also want to give snaps to my spectacular sister Motherwitties Sesch and Molly for providing me with back-up when I had 2 ladies birthing at the same time and needed to leave the hospital to be with my son during his dental surgery. I was leaving them both with women having quite challenging labours, and they are always able to just go in there, adapt, and get to work in their unique, marvellous ways. I didn't worry about any of my clients at all in their good hands, and was able to tend to my little boy fully present for him, if not a little tired from having been up all night. I am so blessed to have a team of women I know love this work, and are deeply honouring of whatever a woman needs to feel supported and good about herself during her birth process.
Lastly, another Kudos to the great Montreal OB nurses who are the busiest ladies in town, yet manage to make their patients feel special and supported. Nurses, who have FAR more patient contact than doctors during birth and are often running around non stop their entire shifts, don't usually forget that they are part of a future memory, and act accordingly.
Friday, May 21, 2010
The Birth of Kayleigh-Savannah
Nineteen years ago today, the world shifted to welcome in a beautiful new being. She happens to be my daughter. Her birth heralded many a change in my world. When her life merged with mine and she began to grow inside me, I found my calling to be a birth attendant. When she emerged from my body, a mother and father were newborn too. So was an Oma, two aunties, and a cousin. The world became a little sweeter that day, and continues to reap the blessings of this good, compassionate, strong, fierce young woman. This is the story of Kayleigh.
Kayleigh's dad and I met 18 months before she was born. The day we met I think we knew we were destined to make a family. I asked him a couple of days after we first laid eyes on each other if he had ever thought of having children. He said that he hadn't thought about it much...would probably consider adopting...but that come to think of it, he might love to have a little girl named Kayleigh (after the song "Kayleigh" by Marillion). With those words, the world of pre-born souls perked up its ears, and a light began to pulse gently, growing and developing, waiting for the perfect moment to spark into life earthside.
I think our child may have been conceived during a thunderstorm in a tent in the Adirondacks. We decided on a whim to go camping out there on my birthday, after having stayed up all night playing Mario Brothers on Nintendo. We left that morning, grabbing a bus. We had planned to stay camping for a few more days after the rain, but missed our dog too much. After taking a canoe out but having to bring it back in quickly because I got a sudden anxiety over sea monsters (even though we were on a lake), we hitchhiked most the way home. We felt a bit odd walking through the US/Canada border after hitching a ride with a guy who listened to the Cowboy Junkies and had a three legged dog named Tripod, but nobody gave us any trouble. We each had a piece of rock hidden in our pockets as our mode of protection against bears and bad guys, but we felt safe in the world. In the middle of my pregnancy, Mitchell used a bit of that rock to put in a pouch he made for me to wear as a kind of amulet of protection.
I could feel my daughter hovering around before she came in. I knew something was going to happen to me, something huge. Before I even missed a period or consciously thought I might be pregnant I was meandering through the "pregnancy and birth" sections of the book store. Mitchell got into a minor bike accident and had a mild concussion, and my mind started to think things like, "he'd better be more careful, because I don't want to be left alone with a child." Hey. Wait a minute! Child? What's going on here? The thought of perhaps having a child left me feeling nothing but excited and happy. There was never a moment of wavering or doubt that this wasn't the perfect thing to do, even though I was only 22, a part time student of English Literature and Creative Writing, and a counter girl at Cafe La Tulipe Noir where I had to don a tuxedo shirt, a bow tie, and a pink visor and apron daily to serve snooty customers cheesecake.
I worked with Mitchell's sister Nancy at La Tulipe. I had a good relationship with her, and trusted her. I mentioned my period might be late. She just gave me a knowing smile. She had had a baby herself at a young age, and her son Jeremy who was then three was an amazing kid we were always trying to steal from her on weekends. We adored Jeremy, and even though Mitchell and I were a pretty new couple, all we wanted to do in our spare time was hang around this little boy. As I washed and folded his sweet little boy clothes one day, I had a strong feeling I would be washing some little clothes for my own kid soon. I bought a pregnancy test. On the same day Murphy Brown found out she was pregnant, the little ball on my pee stick turned blue. Positive.
Naturally, the first person I called immediately was Nancy. "Oh my God, I'm pregnant!" Nancy expressed how great she thought that was, and I was so grateful for such a positive reception of my tender news. Mitchell had no idea. I left the pregnancy test on my desk, and later that evening Mitchell came home, complaining loudly about something that had happened to him during the day. He stopped talking only for a moment to pick up the test and asked, "You're pregnant?" I nodded. Without missing a beat he continued his rant, sat down on the couch, then went silent, breathing rather heavily. We were having a baby. It was a surprise. And it was good.
Next was to tell my family, who were not as receptive. My mom's first reaction was to say, "Oh, NO!" with an exasperated tone that implied I had done something stupid. She didn't intend it to be mean, but of course as a mom she was thinking, "No money, only been with this guy for 9 months, what is my daughter's future?" I don't blame her for that. And she quickly came around. My Nana told me she was glad my Granddad wasn't alive to know I was having a baby out of wedlock, though she herself was very cool about the whole thing.
I'm not sure why this is, but there was never any doubt in my mind that natural birth was the road I wanted to choose. I had always known that. Probably because I come from an unbroken line of natural birthers, my mother having been born at home in Holland, and my mother having given birth naturally to my sisters (twins) and me. My mom only had positive stories of childbearing and breastfeeding, and I have the utmost gratitude that that attitude and belief in birth as a normal process was passed onto me. I would probably not be who I am and do what I do without such a strong legacy as a foundation in my very cells. Even though my mother had 3 children within one year (yes, you heard me correctly), she never complained that it was overwhelming or impossible. She always talked about motherhood as being fun.
I knew unequivocally I was with the very right man to have this baby with on the day we told his mother the big news. We were having dinner at her house with our nephew Jeremy (her grandson), and Mitchell cleared his throat and announced, "So, Jeremy, it looks like you're going to have a little cousin." Mitchell's mom looked up and said, "Say what? You know formula and diapers are expensive, right?" Mitchell said, "Don't worry...we're going to breastfeed and use cloth diapers." How this 22 year old boy pulled this decision out of his hat I have no idea, because we hadn't even discussed it before. But we resonated with its feeling of rightness, and our intuitive mutual connection to our fledgling beliefs made us so happy to be having a baby together.
I felt like the only pregnant woman on earth. I felt so special. I wanted my belly to poke out NOW, so everyone would see how pregnant I was. I felt nauseated, but it wasn't a horrible thing. I felt reassured things were going normally. I had bought a book that was a midwife's guide to birth, so all of it was about natural birth. I never bought one book that was even remotely like What to Expect. I had a gynecologist I really liked, who I had been seeing since I was about 18. When I asked her not to listen to the baby with a Doppler because I was worried about the ultrasound, she said, "Of course!" She informed me she wouldn't be able to hear my baby with a fetoscope then, but that everything looked just fine and we would wait until the baby grew big enough for her to listen to it with a fetoscope. In fact, she appreciated the idea of keeping her auscultation skills intact. I consider myself pretty lucky to have had an OB with such a great attitude.
My husband would walk our big dog Jezebel in Jeanne Mance Park daily, and on his walks he met a couple named Jane and John, who had 2 big white huskies named Yukon and Coltrain. Before I got pregnant, they informed him that Jane was pregnant. One day, Mitchell and I were walking along St. Laurent street. I was feeling pretty green with nausea. I looked up and saw a lovely blonde hippie walking down the street with a swollen belly, flanked by two white dogs. Mitchell said, "Hey, Jane! How are you doing? This is my partner Lesley...she's pregnant too!" Jane looked at me with love and embraced me in the warmest, most present hug I have ever had in my life and said, "That's WONDERFUL! I have something for you." She dug around in her bag and pulled out two books: The Wise Woman Herbal for the Childbearing Year by Susun Weed and Spiritual Midiwfery by Ina May Gaskin. I gratefully accepted these books, and Jane and I exchanged some girl talk. I asked her where she was having her baby, and she said, "At home with a midwife." I han't know that was possible in Montreal. But I immediately asked how I could find a midwife too, because I intuitively knew that no matter now nice my doctor was, I didn't think I was going to enjoy the hospital birth experience. I had assumed that's where all Montrealers went to birth, and was so amazed to know this other option existed, and that I could do it too.
I inhaled the books Jane gave me, and at some point in my careful reading of Spiritual Midwifery, it struck with utter clarity that what I would do with my life was be a birth attendant. Suddenly everything made sense: why I was always so attracted to the birth process, why even as a child I was hungry for birth stories...it was my calling. I have never, not even for one moment, wavered from that belief. I was just so deeply moved to be so overwhelmingly passionate about something that had such meaning to me. How amazing to not only be pregnant, which is pretty great in and of itself, but to discover what I wanted to be when I grew up! Life was fantastic.
I met my midwife Francoise, and loved her right away. I also saw my doctor a couple of more times, who kept her promise and listened to Baby with a fetoscope. I was honest with Dr. B. I told her I was planning to give birth at home. She told me as an OB she had to say she wasn't entirely supportive of that idea, however, if I had to transfer to the hospital for any reason with an emergency in labour, she would do her best to be there for me and would treat the midwife and me without judgement. This made me feel fantastic to know I was covered on all sides. Francoise and Dr. B. suggested I have an ultrasound, because they noted my belly seemed quite large and wanted to rule out the possibility of twins, which run in my family. I agreed. An when I walked into the hospital, I felt so relieved that I would NOT be giving birth there. I told the technician to keep the baby's sex a secret, as I would have felt very strange knowing in advance what the sex of my baby was. I felt deep down she was a girl.
A few family members were a bit challenged with the idea of my choosing to give birth at home. "What if something goes wrong?" they wanted to know. I'm not sure why, but I didn't feel afraid of birthing at home in the least. I felt afraid of being in the hospital. My grandmother put every one's worries to rest, reminding them that she had had her four babies at home, and that in those days where she came from, it was weird to give birth in the hospital where sick people went.
Aside from a few blood sugar issues, pregnancy evolved beautifully. I remember meeting Francoise's back up midwife Kirsten, and she said, "Oh, we just LOVE 22 year olds! They give birth so great!"
Mitchell and I moved to a nice apartment on Park Avenue, having given up our studies to work full time to amass some savings. I stopped working at about six months pregnant, and spent the rest of my pregnancy totally enjoying this new kick of being obsessively clean and organized, which is not part of my normal make-up. At all. I would make Mitchell his lunch and walk the dog over to his work to bring it to him, just like a real housewife. And Mitchell was such a good sport when I made him paint the kitchen twice because I didn't like the colour. I was amazed at how much pleasure I took in smelling clean little baby clothes in their drawers, and the look of clean, white porcelain in the bathroom. I dusted every day. I nested to my heart's content, and enjoyed spending my time reading, resting, cleaning, and preparing for Baby. I fantasized about birth all the time. I knew it would be the hardest thing I had ever done, but I knew I could do it. Just envisioning the moment of my baby being in my arms for the first time would move me to tears.
A few weeks before the birth I met some neighbour children in a park near our library. The girl, who was about 11 said, "You've got a baby in there, don't you? My mom is kind of like a midwife. She helps out at birthings. She had us at home." That was how I met my friend Michelle. She offered to help out and Mitchell and I felt really comfortable with her. She was so warm and open with big hugs and generosity. We had dinner a few times with her and her family and they showed us the photos of their births. I just couldn't believe all the amazing support this baby and I were drawing to us. I felt very guided, and never took for granted that I was walking in a state of grace that was shaping my future in a very important way.
On May 21st, the day before my due date, I woke up to some cramps that felt stronger than the occasional warm up contractions I had been having. At 7am I stood in the shower and and moaned a little, saying, "hmmmm, this is different....I think I'm in labour." Mitchell asked if he should stay home from work. I figured not, because I didn't want to make a big deal of it yet. I knew it could go on for a long time. So off he went. My friend/doula Michelle drove me to my midwife's appointment, as she wanted to meet Francoise. As we waited in Francoise's office, I had a few more waves of sensation, and found I just liked walking and paying attention to them. I had had way worse periods. But they did seem to ask for attention, so I'd stop talking and wander off, walking and breathing gently.
Francoise checked me and said, "Well, you're still 3cm (I had been for 3 weeks), but there is some bloody show and things are softer...maybe I'll see you tonight or tomorrow night."
Michelle wanted to take me to lunch, but I didn't feel like eating much at all. I wanted to be home. So I went and did my routine house tidy. I lay down and took a nap. At about noon Michelle called and told me to eat, so I ate a bit of soup and toast. I just wasn't very hungry. Mitchell came home at about 1pm, and we went to do some groceries. I think we even went to see a movie at the old Rialto Theatre as we lived right across the street from it. Later in the afternoon I began to feel very cranky. The contractions weren't changing much, and I kept thinking all of this might just stop, and if it did I'd be disappointed, because I just really wanted to get the show on the road to meet my baby. I was SO ready for her. My back was feeling tense and sore, and it made me grumpy. Jane came by for a visit, and I sent her and Mitchell off to walk Jezebel because I didn't want to expose them to my bad mood. Mitchell came back, and I was still annoyed because things hadn't really changed. Michelle called to check in, and before she hung up she said, "I just love you SO much!" BOOM, I had a really nice big contraction! After that, they came harder and stronger, and I was happy because finally we were getting somewhere. The sensations were sharper, and I thought these contractions must be "dilators". I called my mom to tell her I was in labour, and I had to put down the phone every time I had a contraction to walk and breath through it, but between I felt normal.
The news was on and I remember feeling interested in watching it between contractions, but that during them, Mitchell and I would laugh and dance. I couldn't just sit still and ignore them, because they were strong. I even crawled around on the floor a bit, cracking up every time Mitchell asked me if I was having another "contractionne". He was going by the book and writing down the time and frequency of the contractions, and they were about every five minutes for a minute or so. That was the last part of the labour we bothered paying too much attention to the time. I felt like I was doing great. The contractions hurt, and I felt like I was working pretty hard to keep on top of them, but that I was happy to be doing it. I felt like I was doing a great job with this labour business...not too badly at all.
I went into the bath after awhile and did some nipple stimulation, because I really didn't want things to slow down. Now the contractions were coming nice and strong, and instead of running around, I breathed slow and long, right down into my belly, and followed my breath out, releasing all the tension into the water. I felt SO good. I had lit candles in the dark bathroom and felt very cozy and peaceful in there. I felt like I could stay there all night. I think Michelle had come over at this point and had sent Mitchell off to bring the dog to his friend's for the night. At some point Michelle noticed that I was a lot less communicative between the contractions, and I started feeling like I wanted Francoise to come over. I got out of the bath, Michelle called her, and she said she was on her way. I noticed a pretty intense pain in my back that seemed to be there regardless of the contractions, and it made me feel tense. I leaned over on my bed during the contractions. Michelle gave me a stupendous massage. Truly, this woman has magic hands. After her massage, the back pain was completely gone.
Mitchell came back home, and Francoise arrived with her assistant Marie Suzanne at about 11:30pm. I was glad to see them because this whole labour thing was getting pretty hard. It didn't seem so fun anymore. I was tired, and wanted to know I was close to having the baby. Francoise checked me and told me I was 4cm. I wanted to throw her out the window. I had been working way over 12 hours for what in my mind amounted to 1 measly, stinking centimetre. At the time, I didn't really understand the irrelevance of numbers in a normally functioning labour, and all I could think was that if I were only 4cm and had to get to 10cm, I was in for a heck of a lot more pain for a much longer time. Waaahhh. I understood in that moment why women chose epidurals, and I was pretty glad I wasn't at a hospital, otherwise I might feel tempted to also. I remember ruing the day I lost my virginity a couple of times, thinking sex was a pretty stupid thing to do. I had hit a wall. When one judges labour in terms of numbers and has an expectation of how things are supposed to progress, the disappointment can be huge. It was a shock to hear Francoise say matter-of-factly, "Yes, 4cm....that's what latent labour is like. I'm going to go unroll my sleeping bag in the baby's room to get some sleep. Marie Suzanne will stay with you." I couldn't believe all this work had just been early labour. Not even enough to warrant my midwife staying awake for! What was I going to do?
So I did what I could. I put one foot in front of the other. I made a mental shift. I figured it was just going to be bigger than I was, but that if so many women had done it, I could too. I walked, and I breathed, I breathed and I walked. As I did so, the room began to fade away. I knew there were people in my living room...Michelle, Marie-Suzanne, Michelle's 11 year old daughter Ovi and our photographer friend Alexandra....but I didn't see them. I was far off in labour land. Between contractions I would find myself in my bedroom in front of the aquarium, the soft bubbling sound very soothing. I saw Mitchell sitting peacefully on the bed, calm and relaxed, enjoying the labour. "Hi, Puppy," he'd say.
At some point I lay down next to Mitchell, Marie-Suzanne sitting next to the bed. I was working hard, and could feel a lot of tension in my body. I would contract and tense up with a ragged breath, and it wasn't feeling great. Then I had a really sharp contraction which made me sit up with surprise at the pain. I literally heard a POP, and my waters broke. There was some blood running down my legs too, but Marie-Suzanne said it was okay. I thought I was going to barf immediately, so I ran to the bathroom, trembling and nauseated. Mitchell followed me in and I could feel a surge swelling and was terrified it was going to engulf me and sweep me away forever. He asked, "Are you okay?" I told him I didn't know what to do. I'll never know what made him, a boy with no experience with labour whatsoever think of this, but he said"why don't you make some noise?" And as that surge peaked I agreed, "ooooookkkkaaaaAAAAAYYYYYYYYYYYYY". After it was done I said, "Wow! That felt great!" I had suddenly found my way to release tension. I knew my spontaneous vocalizing was very loud, and I was happy I had warned my neighbours not to call the cops if they heard some strange noises in the night. I had read about the animal noises some women made in Ina May's book, but nothing had prepared me for the raw, uncontrollable, MASSIVE power expressing its visiting presence in my body through the vehicle of my voice. I jumped into the shower, as under running water in a quiet, dark space is where I feel safest when challenged physically and emotionally. The Tsunami waves would swell and I would yell, the sound increasing as it peaked, decreasing at it decrescendoed, and I could feel myself rising above pain. Yes, there was pain, but it was not horrible. It was unbearably horrible if I didn't yell. Had I had someone in my face trying to control the way I was expressing myself, I would have begged to be knocked out. Vocalization was my personal deliverance from undo-able to the all powerful. What was more present than pain when I was yelling was the sheer intensity of sensation. Mitchell, in support, vocalized with me, but quietly. Why he was not freaked out by this craziness I have no idea, but he looked perfectly calm, comfortable, and loving, vocalizing with me to keep me company.
When I started feeling a little faint in the hot shower, I got back onto the bed. Mitchell lay behind me and held me really tightly, which felt so good because I truly felt I was either going to explode with sensation or levitate with the energy moving through my body. I wasn't thinking at all about a baby. I wasn't really thinking anything. I was just in the moment fully. There was no other way to be. Nature is brilliant, if only we let her be, and knows just what hormones to release at the right times to put us in the right headspace to cope. Part of me was sort of observing, saying, "Lesley, you're being SO dramatic," and another part knew I was doing just fine. I felt no fear. There was no room for anything but surge and rest, surge and rest. My life was not punctuated by a series of contractions anymore...instead of just riding the waves, I became the whole ocean.
Francoise came into the room and asked me if I felt like pushing. She knew by my sounds the baby was coming soon. "NnnnoooooOOOOOOOOGRRRRRRRRR" I said, as I suddenly felt a strong pressure in my pelvic floor. It was not the overwhelming poo feeling I had heard described, but pressure nonetheless. She said she would check me, and I don't remember the exam at all, but she said, "Yes, you're fully dilated." I was shocked. "That's it?" I thought? Not that I was unhappy...not at all...those were sweet words indeed. But I thought it had to get worse somehow. I thought it was going to get bad. But it wasn't bad. Insane, yes, and stronger than anything I had imagined. But I was not miserable. Francoise told me I could start pushing if I wanted. I had gone from 4cm to 10cm in about 2 hours.
A birthing stool was set up for me by my bed, and Mitchell sat on the bed to support me from behind. I started pushing. In hindsight, my doula mind tells me it was too early to push, as I never had a super strong urge at all. But I was doing what was encouraged. Nobody counted or directed much, but when I started pushing I just yelled and yelled. I was guided to push the energy downwards. I started pushing really hard. Someone held a mirror underneath me. The baby's head was slightly visible already. And stayed that way, coming down, and going up...for about 3 hours. Francoise checked the baby's heartrate frequently, and all was well. I was strong. She said my muscles were unusually tight. I explained I had been a gymnast, in whom crazy strong pelvic floors and abs are the norm. I couldn't believe how much energy I had to put out to move the baby down, and I was getting frustrated that it seemed she wasn't moving much at all.
I looked over at my bed and all I could think of was eating food and sleeping. I was truly in an innocent state of Beginner's Mind, which was a good thing. I have seen enough births to know this kind of second stage in a hospital often leads to surgical or instrumental delivery with possible episiotomy. I didn't know this then...I had no idea there was any need for concern. After about 2.5 hours of pushing, Francoise warned me that if the baby wasn't born in a half hour, we would need to transport to the hospital. That lit a fire under my butt. I pushed harder than I could ever imagine possible, easily maintaining that squatting position on the stool. Michelle wanted me to eat a little honey, but I really just wanted to focus. She handfed Mitchell a banana, as he was stuck where he was.
Francoise told me, "Get up and belly dance." So I did. I got up, shook my hips around, then went to sit on the toilet for awhile. I think this is what did it. Soon after more squatting, the baby finally started coming down past my pubic bone. Francoise asked me to get onto the bed, and I did with Mitchell again sitting behind me. A very long crowning process went on. I don't remember a lot of pain, but finally that huge urge to push came upon me where it hadn't been present before. Francoise informed me that the baby's heartrate had gone down under 100 with the last contraction, and that if I didn't give birth in the next contraction or two, she would have to cut me. I couldn't fathom an episiotomy after all that, so I met her challenge and pushed that kid out. Just before her whole head was born Francoise asked me if I wanted to touch her and I reached down and did so, but the strangest sensation filled my body...it was if I was feeling the ache in her head in me, and it felt wrong to touch her squishy little cranium just then. As her head emerged, she began yelling immediately. The rest of her slipped out easily, and all of a sudden I had a warm, wet, wriggly little baby on me. "Oh my God, oh my God!" I cried. What a holy moment. I can't describe it any other way. The sun was just rising, at 5:27 am on the most beautiful day of the year so far. The cats had given some sympathy yowls at the moment of birth. I was a mother.
I couldn't get over that I had a baby. A Baby! I was almost a little afraid of what I could feel to be a powerful soul in her, though I loved her overwhelmingly already. Francoise gave her some homeopathic Arnica because she had the most bruised head I have to this day ever seen on a newborn. The top of her right ear was folded over tightly, and she had a very swollen double cephalic hematoma. Francoise told me had I given birth in the hospital I had planned, she had no doubt it would have ended in a C-section, even though Baby had been just fine throughout. Her APGARS were 9 and 10, and we later found out she weighed 7 pounds, 8 ounces. Francoise told me she had been born facing upwards, and that she had suspected as much. It was only the 2nd Occiput Posterior baby she had seen born at home to a first time mother. I felt pretty beat up, but was blessed with an intact perineum. The birth was challenging, but it was never what I would call harrowing. There was no sense of danger and I trusted it a problem truly arose, my caregivers would direct me to do whatever was necessary for safety's sake.
The placenta was born, the cord cut, the baby covered with a blanket. "Ahem," said Michelle, "but would you like to tell us what flavour baby you've got?" It hadn't occurred to me at all to check the sex of our child! I peeked under the blanket and saw the cut cord. "It's a BOY!" I yelled happily. "Um, look lower, Honey," said Michelle. "Oohhh! It's a GIRL!" I yelled. "Hi Kayleigh!" we, her mother and father, said. A family was born, and a day was never more perfect. We called our nephew Jeremy right away because we had promised he'd be the first to know. He was happy to have a new baby cousin. Then we called my mom, who was now an Oma. She came over with my sisters Auntie Karen and Auntie Jen, and they bore flowers, gifts, and chocolate. We nicknamed our baby Meeper because of the strange little sounds she made. The midwives brought me yogurt and fruit, and Michelle presented us with the beautiful chocolate birthday cake she had baked while I was in labour, decorated with flowers. I felt like a queen. I never realized how deeply special I'd feel, as if I had just gone through something extraordinary, yet such a normal, everyday part of many a woman's life, happening in places all over the world at the same time.
Kayleigh took to the breast immediately, and suckled like a pro to the crooning of Michelle, who in her South Carolina Southern accent coaxed, "Come on, now, Baby, want a little sugar? Take some of your Mama's pretty ninny." In my very long breastfeeding career, from that day forward nursing was always referred to as "having ninny".
Soon the midwives left, and just before they did I asked, "Wait! How often do I change the diaper? And how often do I feed?" They giggled, and gave me a few practical tips. I really was pretty green. The next day Mitchell had to go back to work and I was alone with my baby, and a pile of cloth diapers full of meconium. I think we did just fine. I remember feeling like this was going to be my life now, and very easily slipping into an acceptance of that. While I felt emotional, I just felt full of love and joy, not blue or sad or overwhelmed. I don't think I had ever had enough time in my young life to be enculturated to believe it would all be so hard and exhausting. We were tired, yes, but Kayleigh just slept with us and everything was easier that way. I didn't read parenting books or anything. I just did what came naturally, which turned out to be everything the attachment parenting experts promote. Not bad for a young, green mom.
That was the beginning. And now today that precious baby girl is a grown-up. She is still very much my child. I look at her sometimes when she doesn't realize it, and am just stunned at how quickly that baby grew...through endless colicky days and nights, tandem nursing, homeschooling in the early years, endless lazy days reading Lucy Maude Montgomery, making peirogis, playgroups, friends, Highland Dance and Circus classes, guitar lessons, makeup, boyfriends, highschool, plays, flute concerts, and now Theatre School. I don't know whether it's because of me or in spite of me...perhaps it's a little bit of both...but Kayleigh is a solid person in the world. She is an amazing friend. She has phenomenal social awareness. She is intelligent, and so talented. I don't know what I did to deserve this very daughter for whom tears of love and pride well up frequently in my eyes, though they're not seen, as I'm not a public cryer. My heart is sometimes too tender to express myself, as I feel the tears may never stop. She has patiently been my "experiment kid", living through the inconsistencies, intentions, trials, and errors of having a mom and dad doing this all for the first time the whole way through. I hope she can forgive me the pain I may have caused her through my unawareness but always be able, in moments of sadness and lonliness we humans sometimes have to endure during dark nights, to draw upon the fact that rarely is a human being as loved as deeply and passionately as her mother and father love her.
As I grew and developed into a mother, I also did as a doula. Had it not been for all the synchronicity Kayleigh brought with her on this side of her existence, I probably would not be here telling this story.
I know you get presents today to celebrate your birthday, but I want to thank YOU, my sweet KK, for the gifts of Motherhood and a life path. These are the best gifts I have ever or ever will receive. Thank you for coming to me and helping me to find my voice in the world. While our time as my being your main authority figure is finished, I embrace our relationship as grown up mother and daughter. When I take you into my arms, you are always my baby, my fancy dress loving toddler, my social butterfly school child, my passionate actress daughter, all rolled up into a magnificent young woman. I am so very proud of you.
Happy Birthday!
Monday, May 17, 2010
From the Sublime to the Ridiculous
I will try to keep this from being too long winded. You doulas out there..you know how I feel. We are specialists at supporting the birth process, helping maintain a modicum of its normalcy in a hospital environment that at times can be positively nuts. And oh the suppression sometimes. The suppression of anger, shock, sadness, and even fear. Where did all the logic go? Who killed the wise, ancient woman inside the hearts of many medical practitioners? Not all, obviously, but some? The fact that normal, physiological birth in a hospital setting is considered radical, and that some of my ways of supporting birth are considered annoyances in the light of the Holy God of Protocol, weigh on me heavily. I know all of you have hard times sometimes stomaching the environment, and get tired of your questions to try to gently advocate for your clients being met with rolling eyeballs, snide side glances, or outright ridicule. This is especially frustrating when a lot of the things we as support people know to be the truth about birth are published as studies and validated BY medical people. Are we the only ones reading them? It's not like our information comes from the Barefoot Hippie Encyclopedia. In most cases, anyway.
Let me walk you through a few scenarios that illustrate the source of many doulas' ire. I was with a client who was on her hands and knees on the hospital bed absolutely grooving with her contractions. She was in a trance between, and when one came she would open her eyes widely, say, "Oh guys, this is INTENSE!" then vocalize in that way that gives you goosebumps because it is an utterance of pure, unadulterated, feminine power. The yells got more and more guttural. I was just standing there enjoying those baby arriving sounds, not needing to do anything for this woman but protect her space. I could hear whispers in the background..."she won't keep her monitor belt on, and it's very annoying." I understand these kinds of births ARE hard on nurses, because they cannot monitor the woman they way they are supposed to. But another nurse kindly said, "oh, don't worry, I'll just hold the monitor." So she got on her knees on the floor to hold the transducer on my client's belly, and I sent her a silent blessing, as she healed the moment. There is no need to express annoyance. The labouring woman needs nothing else to bear but the intensity of her labour. To feel like a burden or doubt that she's doing okay given impatient comments in the room is hurtful. I would like expressions of annoyance or words that indicate the woman, having an experience of a lifetime, is being a drag on the busy nurse's day to be kept to a minimum. Birth is awe inspiring. It hasn't lost its magic for me in over 16 years of practice. If a woman wants me to stand on my head to accommodate her in labour, I will. HELLO, this woman is giving life, People! She is bringing a new human being into the world! Do we really need a vision of an angel to appear over her head, or a white bearded sky dude to materialize and put a finger over his lips to indicate to the annoyed to shut up and respect the fact that something very special is happening in the room? Because you're just not going to find anything that embodies the sacred in the here and now more than a birthing.
I was with a woman pushing spontaneously her own way. She was a first time mama, labouring like a lioness...making powerful noises, her body doing its baby ejection thing. She didn't need anything but an occasional sip of water. After easing into pushing like this totally on her own without any guidance or examinations, seeming to be having a pretty good time, a resident marched in, made her flip over onto her back, and did an exam, saying, "Okay, now it's fine for you to push..let's get you set up." Inside I'm seething, but as my Navelgazing Midwife blogger buddy says, "Buy a hospital ticket, get a hospital ride." If I'm a hospital birth supporting doula, I have to support what is, not always what I wish would be. When I'm supporting a woman and the environment is especially challenging, I often think of the theme song from the United States of Tara, which is a tv show about the chaotic, sometimes joyful, often devastating life of a wife and mother with multiple personalities. The song goes, "I know we'll be just fine, when we learn to love the ride." But oh, what a ride! You never know when you walk into the hospital what you're going to be met with. Some days everything clicks and converges to support an amazingly lovely normal birth. Other times, it seems as if everyone is in an awful mood and are taking it out on you. Sometimes it's downright violent. Going to the hospital is sometimes like dealing with a whole building with a dissociative identity disorder. I can never promise a client any consistency of kindness or respect there, and that seems incredibly wrong. Should these things not be at the foundation of patient care? It's not that some of people are uncompassionate in their hearts, it's just that sometimes compassion is squelched by duty, overwork, worry, stress, and responsibility, ultimately making the kind treatment of a patient secondary to smooth running of the institutional machine.
I digress...back to my story. This lady is told to start pushing, and on her back continues to do it the same way she has been, emitting nice yells and not holding her breath. The baby is already partially visible. She hasn't pushed spontaneously for long, and already we can the head a little. She is told, "You're not pushing correctly. It's not good for you to waste your energy yelling. It's not good for you to push for longer than you need to. You need to take a deep breath, block your air, force your energy..." yada yada..turn purple, bug out your eyes, hold your breath, strain your perineum. The mother does so and hates it. I whisper to her that she has done a tremendous job listening to her body so far, having moved her baby down without any guidance at all. I try to do this in a way that will evoke no criticism or ridicule. But it's hard. There is such an attachment to one way of doing things, any variation tends to be looked upon as radical and some kind of hippie doula thing, instead of a physiological fact, supported by lots of smarter and more educated folk than I. A nurse heard me and said, "No, it's logical, if you take a deep breath and..." yada yada...pretend you're a pop gun, intra-uterine pressure, must-be-yelled-at-to-not-yell, harder harder HARDER.....NOW YOU'RE PUSHING PROPERLY!!!!! As if those previous independent maternal efforts had been worthless, because they were not sanctified. There is no trust. Did I argue that had she been left alone on her knees she may not have had to have pushed so hard to move the baby down, as being turned onto the back closes the pelvis by 30%? If the baby is trying, in executing her little cardinal movements, to push the sacrum away with her face, initiating the extension of her head, does it not make sense that having the sacrum immobilized between the bed and the head could impede things, and that the purple pushing serves as compensation for this fact, the pulling of the knees to the ear creating a little more space but actually creating a powerful strain on the poor perineum? No, I did not argue, because I had to tend to the lady before me. I didn't want to create tension. That maybe the fetal distress that created a need for an episotomy and ensuing 4th degree tear may have been avoided I truly cannot say...not my place to judge given my lack of clinical knowledge. But I can say the undermining of power and personal preferences of a woman in birth is shocking, and that it seems to me there is always some emergency that comes up and everyone thanks God the mother and baby were in those good hands. And yeah, sometimes that's the honest truth. But a lot of the time I think the problems are created by interference that is supposed to serve as precaution and preparation for emergency. As I get older it gets harder to reconcile that we have not struck a balance and achieved the great outcomes we COULD have, like in the Netherlands, where obstetric care is used for problems, and midwifery care is used for normal birth. When birth is in the hands of those who consider it...well, normal..isn't it interesting how fewer emergencies there actually are. And when the unexpected does occasionally arise, we have those wonderfully gifted OBs to do the jobs they're great at, which is to identify and treat birth complications. I am grateful for their presence, I truly am. But do we always need such hardcore protection for something that is usually pretty straightforward and normal? Isn't it apparent that to turn a woman doing her own thing, bringing her baby down in her own way, onto her back to start poking around and telling her what to do and how to do it is an intervention that probably causes more problems than it prevents?
And the blame. There is so much blame on women and natural birth. The mom is yelling, so she's not doing well and is "out of control". She is "not handling it". How many traumatized women are walking around buying that either their pelvises are too small or their babies were too big? Perhaps in some cases this is true, but I know SO many women who believe this about their bodies, you'd think we would be on the edge of extinction with all the inadequacies of our bodies. A client of mine was told that her shockiness and fatigue after birth to the point of not being able to hold her child was attributed to having experienced the strong sensations (called "traumatizing pain") of labour instead of having been cut and torn completely. And sometimes if something does go wrong in natural birth, the fact that the mother chose to do it that way is implied as the probable cause. Do we realize yet the power we have in our hands with all our great technology and life saving skills is not realized when our attitudes towards women and birth are still medeival?
Let me outline a beautiful scenario to end this rant, moments such as these restoring my faith and joy in the possibility of gorgeous hospital birth. Imagine a woman in the throes of spontaneous pushing. She is dancing and writhing to the rhythm of her own contractions. The nurse is a little frantic, trying to get her to lie down. As much compassion as I have for this actually very nice nurse, it's not my job to make her life convenient. I simply behold the work of my client, offering myself as something solid to lean against and cling to, which she does liberally. In walks a doctor I have not seen...a young feisty woman. The nurse is trying to tell the woman how to push. This doctor is with a resident she's teaching. The doc says quietly to her resident, "you know all this talk about telling a woman to push? Well, studies show we're probably doing the woman a disservice, making her uncomfortable and putting tremendous strain on all of her, including her perineum. It may take a little longer to see the baby, but it's gentler." The nurse suggested to this doctor to "break the bed" to get her pushing "properly" and the doctor efficiently said, "you can listen to the fetal heart, I'll worry about the delivery." She proceeded to tell her resident, "Mothers seem to know what they're doing, and we don't really need to tell them much...our job is to follow." And follow she did, contorting into whatever position was necessary to safely accommodate the woman who liked to move around a lot to give birth the way she wanted. What a beautiful treat for everyone! Why can't it all be like this?
Don't give up, Doulas. I keep doing this job because the incidence of amazingly gorgeous, normal birth experiences in hospitals is on the rise in my neck of the woods. It could be because having been around for a little while and knowing the staff of most hospitals here fairly well seems to help set a tone when I come in with my client. When we're a room full of trusted friends, the energy is good, and we all appreciate each other. There are fantastic medical practitioners who truly do care about the woman's experience of birth, and can seem to balance being accommodating to those needs and providing the medical care they have signed on for. It IS possible. Keep at it, Ladies. We need you! Don't get discouraged. You are making a difference, and I love you all for it.
Let me walk you through a few scenarios that illustrate the source of many doulas' ire. I was with a client who was on her hands and knees on the hospital bed absolutely grooving with her contractions. She was in a trance between, and when one came she would open her eyes widely, say, "Oh guys, this is INTENSE!" then vocalize in that way that gives you goosebumps because it is an utterance of pure, unadulterated, feminine power. The yells got more and more guttural. I was just standing there enjoying those baby arriving sounds, not needing to do anything for this woman but protect her space. I could hear whispers in the background..."she won't keep her monitor belt on, and it's very annoying." I understand these kinds of births ARE hard on nurses, because they cannot monitor the woman they way they are supposed to. But another nurse kindly said, "oh, don't worry, I'll just hold the monitor." So she got on her knees on the floor to hold the transducer on my client's belly, and I sent her a silent blessing, as she healed the moment. There is no need to express annoyance. The labouring woman needs nothing else to bear but the intensity of her labour. To feel like a burden or doubt that she's doing okay given impatient comments in the room is hurtful. I would like expressions of annoyance or words that indicate the woman, having an experience of a lifetime, is being a drag on the busy nurse's day to be kept to a minimum. Birth is awe inspiring. It hasn't lost its magic for me in over 16 years of practice. If a woman wants me to stand on my head to accommodate her in labour, I will. HELLO, this woman is giving life, People! She is bringing a new human being into the world! Do we really need a vision of an angel to appear over her head, or a white bearded sky dude to materialize and put a finger over his lips to indicate to the annoyed to shut up and respect the fact that something very special is happening in the room? Because you're just not going to find anything that embodies the sacred in the here and now more than a birthing.
I was with a woman pushing spontaneously her own way. She was a first time mama, labouring like a lioness...making powerful noises, her body doing its baby ejection thing. She didn't need anything but an occasional sip of water. After easing into pushing like this totally on her own without any guidance or examinations, seeming to be having a pretty good time, a resident marched in, made her flip over onto her back, and did an exam, saying, "Okay, now it's fine for you to push..let's get you set up." Inside I'm seething, but as my Navelgazing Midwife blogger buddy says, "Buy a hospital ticket, get a hospital ride." If I'm a hospital birth supporting doula, I have to support what is, not always what I wish would be. When I'm supporting a woman and the environment is especially challenging, I often think of the theme song from the United States of Tara, which is a tv show about the chaotic, sometimes joyful, often devastating life of a wife and mother with multiple personalities. The song goes, "I know we'll be just fine, when we learn to love the ride." But oh, what a ride! You never know when you walk into the hospital what you're going to be met with. Some days everything clicks and converges to support an amazingly lovely normal birth. Other times, it seems as if everyone is in an awful mood and are taking it out on you. Sometimes it's downright violent. Going to the hospital is sometimes like dealing with a whole building with a dissociative identity disorder. I can never promise a client any consistency of kindness or respect there, and that seems incredibly wrong. Should these things not be at the foundation of patient care? It's not that some of people are uncompassionate in their hearts, it's just that sometimes compassion is squelched by duty, overwork, worry, stress, and responsibility, ultimately making the kind treatment of a patient secondary to smooth running of the institutional machine.
I digress...back to my story. This lady is told to start pushing, and on her back continues to do it the same way she has been, emitting nice yells and not holding her breath. The baby is already partially visible. She hasn't pushed spontaneously for long, and already we can the head a little. She is told, "You're not pushing correctly. It's not good for you to waste your energy yelling. It's not good for you to push for longer than you need to. You need to take a deep breath, block your air, force your energy..." yada yada..turn purple, bug out your eyes, hold your breath, strain your perineum. The mother does so and hates it. I whisper to her that she has done a tremendous job listening to her body so far, having moved her baby down without any guidance at all. I try to do this in a way that will evoke no criticism or ridicule. But it's hard. There is such an attachment to one way of doing things, any variation tends to be looked upon as radical and some kind of hippie doula thing, instead of a physiological fact, supported by lots of smarter and more educated folk than I. A nurse heard me and said, "No, it's logical, if you take a deep breath and..." yada yada...pretend you're a pop gun, intra-uterine pressure, must-be-yelled-at-to-not-yell, harder harder HARDER.....NOW YOU'RE PUSHING PROPERLY!!!!! As if those previous independent maternal efforts had been worthless, because they were not sanctified. There is no trust. Did I argue that had she been left alone on her knees she may not have had to have pushed so hard to move the baby down, as being turned onto the back closes the pelvis by 30%? If the baby is trying, in executing her little cardinal movements, to push the sacrum away with her face, initiating the extension of her head, does it not make sense that having the sacrum immobilized between the bed and the head could impede things, and that the purple pushing serves as compensation for this fact, the pulling of the knees to the ear creating a little more space but actually creating a powerful strain on the poor perineum? No, I did not argue, because I had to tend to the lady before me. I didn't want to create tension. That maybe the fetal distress that created a need for an episotomy and ensuing 4th degree tear may have been avoided I truly cannot say...not my place to judge given my lack of clinical knowledge. But I can say the undermining of power and personal preferences of a woman in birth is shocking, and that it seems to me there is always some emergency that comes up and everyone thanks God the mother and baby were in those good hands. And yeah, sometimes that's the honest truth. But a lot of the time I think the problems are created by interference that is supposed to serve as precaution and preparation for emergency. As I get older it gets harder to reconcile that we have not struck a balance and achieved the great outcomes we COULD have, like in the Netherlands, where obstetric care is used for problems, and midwifery care is used for normal birth. When birth is in the hands of those who consider it...well, normal..isn't it interesting how fewer emergencies there actually are. And when the unexpected does occasionally arise, we have those wonderfully gifted OBs to do the jobs they're great at, which is to identify and treat birth complications. I am grateful for their presence, I truly am. But do we always need such hardcore protection for something that is usually pretty straightforward and normal? Isn't it apparent that to turn a woman doing her own thing, bringing her baby down in her own way, onto her back to start poking around and telling her what to do and how to do it is an intervention that probably causes more problems than it prevents?
And the blame. There is so much blame on women and natural birth. The mom is yelling, so she's not doing well and is "out of control". She is "not handling it". How many traumatized women are walking around buying that either their pelvises are too small or their babies were too big? Perhaps in some cases this is true, but I know SO many women who believe this about their bodies, you'd think we would be on the edge of extinction with all the inadequacies of our bodies. A client of mine was told that her shockiness and fatigue after birth to the point of not being able to hold her child was attributed to having experienced the strong sensations (called "traumatizing pain") of labour instead of having been cut and torn completely. And sometimes if something does go wrong in natural birth, the fact that the mother chose to do it that way is implied as the probable cause. Do we realize yet the power we have in our hands with all our great technology and life saving skills is not realized when our attitudes towards women and birth are still medeival?
Let me outline a beautiful scenario to end this rant, moments such as these restoring my faith and joy in the possibility of gorgeous hospital birth. Imagine a woman in the throes of spontaneous pushing. She is dancing and writhing to the rhythm of her own contractions. The nurse is a little frantic, trying to get her to lie down. As much compassion as I have for this actually very nice nurse, it's not my job to make her life convenient. I simply behold the work of my client, offering myself as something solid to lean against and cling to, which she does liberally. In walks a doctor I have not seen...a young feisty woman. The nurse is trying to tell the woman how to push. This doctor is with a resident she's teaching. The doc says quietly to her resident, "you know all this talk about telling a woman to push? Well, studies show we're probably doing the woman a disservice, making her uncomfortable and putting tremendous strain on all of her, including her perineum. It may take a little longer to see the baby, but it's gentler." The nurse suggested to this doctor to "break the bed" to get her pushing "properly" and the doctor efficiently said, "you can listen to the fetal heart, I'll worry about the delivery." She proceeded to tell her resident, "Mothers seem to know what they're doing, and we don't really need to tell them much...our job is to follow." And follow she did, contorting into whatever position was necessary to safely accommodate the woman who liked to move around a lot to give birth the way she wanted. What a beautiful treat for everyone! Why can't it all be like this?
Don't give up, Doulas. I keep doing this job because the incidence of amazingly gorgeous, normal birth experiences in hospitals is on the rise in my neck of the woods. It could be because having been around for a little while and knowing the staff of most hospitals here fairly well seems to help set a tone when I come in with my client. When we're a room full of trusted friends, the energy is good, and we all appreciate each other. There are fantastic medical practitioners who truly do care about the woman's experience of birth, and can seem to balance being accommodating to those needs and providing the medical care they have signed on for. It IS possible. Keep at it, Ladies. We need you! Don't get discouraged. You are making a difference, and I love you all for it.
Sunday, May 9, 2010
Happy Mother's Day
Happy Mother's Day, Ladies!!!!! This goes out with special warmth to all of you who are having your very first Mother's Day today.
I like the concept of Mother's Day as a reason to take some special time to honour ourselves and each other for our important role, but I don't buy into the whole Cards and Flowers thing. Partly because I'm not a sappy person. I enjoy sappy people immensely, but I'm not one of them. The only things I'm really sentimental about are old baby clothes, teeth, placentas, and silky locks from first haircuts. I don't have a backlog of birthday cards or a piece of wall that marks my childrens' changing height...I don't have baby scrap books or anything like that. I care about my children as much as the next guy, but I'm not bogged down with material momentos. I'm way too disorganized for that. Kudos to those who are good record keepers. My traditions are kept by simple storytelling, otherwise we'd lose our history entirely.
A perfect Mother's Day to me would be to sleep without one single, solitary interruption, have all the tedious things I normally have to do on a Sunday to make sure chaos doesn't reign supreme the rest of the week taken care of for me, and freedom from having to decide what's for supper. Being a mom is hard. Harder than anything. I don't mean it's not joyful, heartwarming, amazing, fulfilling and all those great things. But it is complicated. Often it is overwhelmingly stressful. Let's be real...on occasion, a day that would honour ourselves would mean taking a day off from all of this, so we could come back refreshed, centred, and ready to keep going strong. I am SO grateful to have children. They are the reasons for my being. They enrich me beyond measure, and I let them know that all the time. I would like Mother's Day to be a nationally enforced Mother's Day Off Her Regular Duties day. Not only would it make us feel good, it would remind others just how much stuff we do all the time. It would also give us time to connect to the magic of being a mother. It can be hard to step back and get some perspective when we're always trying to get on top of all that needs to be done to make things run at all, never mind smoothly.
I decided this Mother's Day to do something special, something that would make me feel really connected to the joy and amazement of motherhood, and to make my youngest child feel special too. I finally decided to bury Finn's placenta, which has been sitting in the freezer for nearly 5 years, patiently waiting for me to figure out what to do with it. In the photos, you can see it's pretty knarly looking, having been frozen for 5 years. Today, we planted it along with a gorgeous baby flowering crabapple tree, fitting for the strong, sweet, beautiful Finnie he is. He placed a rose in beside it to say, "Thank you". I contemplated with some sadness how this will be the last of my placentas I say goodbye to. I have had at least one (and at times 3)6 year or under child to care for for 18 years. This planting symbolizes the completeness of my family. Before we planted, I found a tiny crow's feather beside a white rose bush my husband had planted last week. To me, this was auspicious, as crows have always meant nothing but good things in my life. Crow reminds us that magic is real, and provides us with good luck on our travels. I will keep that feather for Finn, as a symbol of his link to that which helped form and nourish him so well. I know many of you Westerners think this is gross, weird, and hokey, giving second thought to a used up organ that looks like liver...but there you go. I will officially have to bow out of the Facebook Group "I have a placenta in my freezer...I'm not kidding," because it is now safely in the ground, nourishing a tree that will grow and become a protective, beautiful part of our home's landscape.
Happy Mother's Day, Friends. I hope you were able to create a little magic today to honour yourselves.
Thursday, May 6, 2010
An Interesting Perspective on Post- Datism
I came across this from a couple of friends who sent this to me a year or two ago. It really sheds an interesting light on the fears surrounding postdatism. It is an exerpt from a forum on the subject, by an Australian doctor.
"In the eight years when I practiced homebirths as a registered
doctor, out of 1,190 bookings I had 106 post mature babies (more than forty-
two weeks) of which three went to forty-eight weeks, a few more went to
forty-six weeks, and lots went to forty-four weeks—and all those babies
fared very well. I did lose one at forty-two weeks, which is not outside
the obstetricians' limit. Of those 106 post mature babies, only one fitted
the textbook description of post maturity, looking like a little wrinkled
old man with stained skin, but that baby was extremely alert, and insisted on
looking around the room instead of suckling.
What decided me to do no inductions for post-maturity was a very early
mother in my homebirth series who refused induction despite my anxiety,
went to forty-four and a half weeks and gave birth to a chubby pink,
strong,healthy baby, with absolutely no sign of post maturity. If I had lost
one of those 106 babies who went past forty-two weeks, obviously I would have
done some deep soul-searching, but I doubt whether I would have changed my
mind.
Babies mature at different rates, not at exactly forty weeks, just as
we adults do not become senile at seventy years.
Some might say I was lucky to deliver 106 post mature babies without
losing one, but remember that my clients were mostly very health-conscious,
especially regarding diet. None of them was driven to homebirth by
financial difficulties—quite the reverse. In Australia it is far cheaper to
birth your baby in hospital. I should also mention that I tend to disregard
meconium as a supposed sign of fetal distress, because of other possible causes,
for example, if the mother took laxatives.
I feel the advice from the midwives was always correct. I would not
rely on ultrasound to establish dates. The best check, if the mother presents
early enough, is that before ten weeks the fetal heart is more than 160,
often 180, but by twelve weeks it usually settles to 144 or less. But my
present mood is—don't be fussy about dates. When you estimate the due date (I
use 283 days, i.e. nine months and ten days, slightly more accurate than
the received forty weeks), also advise the prospective parents not to tell
friends and relatives the precise date, but be vague, like "before the new
year" or "before Thanksgiving," so that they will not be pestered by
nervous well-wishers if they go past the "due" date.
Marion's response in The Birthkit Issue 25 is very good ["A CNM
Discusses Post maturity Syndrome"], but I must take issue with one sentence. She
says "Post maturity syndrome has recognized signs, and that's why the
pediatrician who tried to resuscitate Barbaranne's baby knew it was forty-four
weeks." With the background of my experience with post mature babies, which is
far more comprehensive than most other practitioners under the rule of
induction at forty-two weeks or earlier, I have to assert categorically that the
so-called recognized signs of post maturity are fallacious because
babies mature at different rates. Those signs are practically never due to
real post maturity, they are more likely to be due to other factors like a
severe illness during pregnancy, or placental infarction well before term. I
knew that post maturity signs were unreliable long before I ever started
attending homebirths, because I can still remember the famous and respected
pediatrician Kate Campbell telling us students about post mature
babies having long hair and long fingernails and other signs, and premature
babies having the reverse. But once I got into general practice and was
delivering babies in hospital, I noticed that those signs were most unreliable,
and that some babies born before term had long fingernails and hair, and
some babies born after term did not. In any case I cannot share Marion's
confidence that the pediatrician who tried to resuscitate the baby
knew it was forty-four weeks, even though he said so. I know pediatricians and
obstetricians better than to trust a statement like that."
Dr. John Stevenson
Victoria, Australia
"In the eight years when I practiced homebirths as a registered
doctor, out of 1,190 bookings I had 106 post mature babies (more than forty-
two weeks) of which three went to forty-eight weeks, a few more went to
forty-six weeks, and lots went to forty-four weeks—and all those babies
fared very well. I did lose one at forty-two weeks, which is not outside
the obstetricians' limit. Of those 106 post mature babies, only one fitted
the textbook description of post maturity, looking like a little wrinkled
old man with stained skin, but that baby was extremely alert, and insisted on
looking around the room instead of suckling.
What decided me to do no inductions for post-maturity was a very early
mother in my homebirth series who refused induction despite my anxiety,
went to forty-four and a half weeks and gave birth to a chubby pink,
strong,healthy baby, with absolutely no sign of post maturity. If I had lost
one of those 106 babies who went past forty-two weeks, obviously I would have
done some deep soul-searching, but I doubt whether I would have changed my
mind.
Babies mature at different rates, not at exactly forty weeks, just as
we adults do not become senile at seventy years.
Some might say I was lucky to deliver 106 post mature babies without
losing one, but remember that my clients were mostly very health-conscious,
especially regarding diet. None of them was driven to homebirth by
financial difficulties—quite the reverse. In Australia it is far cheaper to
birth your baby in hospital. I should also mention that I tend to disregard
meconium as a supposed sign of fetal distress, because of other possible causes,
for example, if the mother took laxatives.
I feel the advice from the midwives was always correct. I would not
rely on ultrasound to establish dates. The best check, if the mother presents
early enough, is that before ten weeks the fetal heart is more than 160,
often 180, but by twelve weeks it usually settles to 144 or less. But my
present mood is—don't be fussy about dates. When you estimate the due date (I
use 283 days, i.e. nine months and ten days, slightly more accurate than
the received forty weeks), also advise the prospective parents not to tell
friends and relatives the precise date, but be vague, like "before the new
year" or "before Thanksgiving," so that they will not be pestered by
nervous well-wishers if they go past the "due" date.
Marion's response in The Birthkit Issue 25 is very good ["A CNM
Discusses Post maturity Syndrome"], but I must take issue with one sentence. She
says "Post maturity syndrome has recognized signs, and that's why the
pediatrician who tried to resuscitate Barbaranne's baby knew it was forty-four
weeks." With the background of my experience with post mature babies, which is
far more comprehensive than most other practitioners under the rule of
induction at forty-two weeks or earlier, I have to assert categorically that the
so-called recognized signs of post maturity are fallacious because
babies mature at different rates. Those signs are practically never due to
real post maturity, they are more likely to be due to other factors like a
severe illness during pregnancy, or placental infarction well before term. I
knew that post maturity signs were unreliable long before I ever started
attending homebirths, because I can still remember the famous and respected
pediatrician Kate Campbell telling us students about post mature
babies having long hair and long fingernails and other signs, and premature
babies having the reverse. But once I got into general practice and was
delivering babies in hospital, I noticed that those signs were most unreliable,
and that some babies born before term had long fingernails and hair, and
some babies born after term did not. In any case I cannot share Marion's
confidence that the pediatrician who tried to resuscitate the baby
knew it was forty-four weeks, even though he said so. I know pediatricians and
obstetricians better than to trust a statement like that."
Dr. John Stevenson
Victoria, Australia
Tuesday, May 4, 2010
Hypervigilance and Negligence
The more I doula (yes, I use the word "doula" as a verb with impunity), the more I see terrible imbalances in hospitals between hyper vigilance and negligence.
I'm not a clinician of any sort, and I appreciate the medical care that is given to my clients to help them have a safe birth. But some things don't look so safe, and it strikes me as very strange sometimes what is focused on, and what goes under the radar.
I have questions. If a woman's waters have been broken for a certain amount of time, infection becomes a huge concern for the hospital staff. Synto is started if labour doesn't start at what they deem is an appropriate time. I know there are other reasons besides infection women are told to go immediately to the hospital when their waters are broken, but the reason mainly told to the birthing women themselves is so the staff can monitor for and treat potential infection. But if a woman has to hang out in the hospital, which is crawling with germs, and be examined frequently (they say they won't do it a lot with broken waters but still do anyway a lot of the time), which pushes bacteria wombwards, how does this help her deal with potential infection? Not only that, but a couple hospitals here don't use sterile gloves for examining a woman with broken waters. Many staff members will come into the room, NOT wash their hands, rummage around in the little box with the regular examination gloves, and do vaginal exams with those. So their hands, which have goodness knows what germs on them, contact the gloves they wear for the exam as well as some other gloves in the box (which will contaminate the hands of those who HAVE washed). And then they examine the cervices of women whose waters are broken telling them how worried they are about infection. Hmmmm. Meanwhile, evidence shows labour stimulation can increase the rate of C-section....which increases the chance of infection.
I had a client recently whose waters broke with an exam, and she was told that in 4 hours, if she didn't birth, she'd be given an IV and Synto, etc. But hello, the water was thick with brown meconium, and was pouring out in great gushes. After all this talk of infection and interventions for the prevention of infection, I wonder why nobody thought to listen to the baby's heart after those waters released. As a doula, if I see meconium in the waters, I high tail it to the hospital. I have to, because I'm not in a position to monitor a baby. I understand that meconium is a potential sign of distress. So if it's a potential sign of distress, why would they have waited over an hour before monitoring the baby, favouring to focus on the evils of potential infection?
I have seen incredible hyper vigilance over a woman's pain with a pointed obsession to eradicate it, but lack of attention to the actual birth. I have heard doctors, even when their patients are fully dilated, strongly encourage them to take an epidural because the pain will only get worse (?????). Some are so focused on draping those sterile sheet jobbies all over the mom because birth is all dirty and we need to prevent infection (again) for her and her baby (?????), the baby practically falls on the floor because the actual WOMAN is receiving no attention when she's yelling THE BABY IS COMING! Or, they go and cut a woman's perinuem par routine, which can cause terrible pain and infection, in spite of all this talk about HAVING to do things to prevent infection. Or in all the fuss about pain and infection, the damn resuscitation equipment has not been checked to ensure it's working properly (and yes, I have been in situations where a baby needed this equipment and it wasn't immediately available because it hadn't been properly set up).
I have stories. Oh, I have stories. I don't tell most of them to protect the privacy of my clients. I also don't want the mistake of one person to colour a person's entire view of the hospital. I don't want to breed mistrust. But maybe this is why doulas are having issues in the hospital...not because we actually offend and antagonize the staff with even our most gentle questions, but because we are the witness in the room.
I'm feeling a little raw from a couple of RIDICULOUS things I have seen in hospitals this past week. I don't expect perfection from nurses and doctors, and many of the things that go on are not their fault...sometimes it's administration and understaffing or auxiliary staff issues. But it would be nice to be able to trust that the important things will be tended to immediately, the rare potentials will be inconspicuously prepared for but not obsessed over, said obsession leaving little room for presence for the here and now, and people saying things that make SENSE. I cannot tell you how tired I am of reasons being seemingly plucked out of the air to justify actions. I heard someone say to a client of mine who wanted to push on her side, the practitioner being very uncomfortable with this position, "well, um..it's not safe to push that way because the pressure of your arm against your inner thigh could cause an embolism." How's that for evidence based practice?! How's that for fear mongering? Even an honest, "I'm just not comfortable with this position due to a lack of experience with it,' would be acceptable rather than that garbage. I just don't get this system sometimes. Not at all. And nobody seems to be able to give consistent answers, and culpability can be iffy. But if I even take on a tone in my voice that is perceived as (though it isn't intended to be) snippy, I could potentially be black listed, laughted at, yelled at, insulted, and hated on sight. Doula work is beautiful, amazing, and wonderful....but it is not for the feint of heart.
I'm not a clinician of any sort, and I appreciate the medical care that is given to my clients to help them have a safe birth. But some things don't look so safe, and it strikes me as very strange sometimes what is focused on, and what goes under the radar.
I have questions. If a woman's waters have been broken for a certain amount of time, infection becomes a huge concern for the hospital staff. Synto is started if labour doesn't start at what they deem is an appropriate time. I know there are other reasons besides infection women are told to go immediately to the hospital when their waters are broken, but the reason mainly told to the birthing women themselves is so the staff can monitor for and treat potential infection. But if a woman has to hang out in the hospital, which is crawling with germs, and be examined frequently (they say they won't do it a lot with broken waters but still do anyway a lot of the time), which pushes bacteria wombwards, how does this help her deal with potential infection? Not only that, but a couple hospitals here don't use sterile gloves for examining a woman with broken waters. Many staff members will come into the room, NOT wash their hands, rummage around in the little box with the regular examination gloves, and do vaginal exams with those. So their hands, which have goodness knows what germs on them, contact the gloves they wear for the exam as well as some other gloves in the box (which will contaminate the hands of those who HAVE washed). And then they examine the cervices of women whose waters are broken telling them how worried they are about infection. Hmmmm. Meanwhile, evidence shows labour stimulation can increase the rate of C-section....which increases the chance of infection.
I had a client recently whose waters broke with an exam, and she was told that in 4 hours, if she didn't birth, she'd be given an IV and Synto, etc. But hello, the water was thick with brown meconium, and was pouring out in great gushes. After all this talk of infection and interventions for the prevention of infection, I wonder why nobody thought to listen to the baby's heart after those waters released. As a doula, if I see meconium in the waters, I high tail it to the hospital. I have to, because I'm not in a position to monitor a baby. I understand that meconium is a potential sign of distress. So if it's a potential sign of distress, why would they have waited over an hour before monitoring the baby, favouring to focus on the evils of potential infection?
I have seen incredible hyper vigilance over a woman's pain with a pointed obsession to eradicate it, but lack of attention to the actual birth. I have heard doctors, even when their patients are fully dilated, strongly encourage them to take an epidural because the pain will only get worse (?????). Some are so focused on draping those sterile sheet jobbies all over the mom because birth is all dirty and we need to prevent infection (again) for her and her baby (?????), the baby practically falls on the floor because the actual WOMAN is receiving no attention when she's yelling THE BABY IS COMING! Or, they go and cut a woman's perinuem par routine, which can cause terrible pain and infection, in spite of all this talk about HAVING to do things to prevent infection. Or in all the fuss about pain and infection, the damn resuscitation equipment has not been checked to ensure it's working properly (and yes, I have been in situations where a baby needed this equipment and it wasn't immediately available because it hadn't been properly set up).
I have stories. Oh, I have stories. I don't tell most of them to protect the privacy of my clients. I also don't want the mistake of one person to colour a person's entire view of the hospital. I don't want to breed mistrust. But maybe this is why doulas are having issues in the hospital...not because we actually offend and antagonize the staff with even our most gentle questions, but because we are the witness in the room.
I'm feeling a little raw from a couple of RIDICULOUS things I have seen in hospitals this past week. I don't expect perfection from nurses and doctors, and many of the things that go on are not their fault...sometimes it's administration and understaffing or auxiliary staff issues. But it would be nice to be able to trust that the important things will be tended to immediately, the rare potentials will be inconspicuously prepared for but not obsessed over, said obsession leaving little room for presence for the here and now, and people saying things that make SENSE. I cannot tell you how tired I am of reasons being seemingly plucked out of the air to justify actions. I heard someone say to a client of mine who wanted to push on her side, the practitioner being very uncomfortable with this position, "well, um..it's not safe to push that way because the pressure of your arm against your inner thigh could cause an embolism." How's that for evidence based practice?! How's that for fear mongering? Even an honest, "I'm just not comfortable with this position due to a lack of experience with it,' would be acceptable rather than that garbage. I just don't get this system sometimes. Not at all. And nobody seems to be able to give consistent answers, and culpability can be iffy. But if I even take on a tone in my voice that is perceived as (though it isn't intended to be) snippy, I could potentially be black listed, laughted at, yelled at, insulted, and hated on sight. Doula work is beautiful, amazing, and wonderful....but it is not for the feint of heart.
Saturday, May 1, 2010
I'm Still Here
It has been awhile since my last blog...just to let you know I'm still here. I am focusing all of my energy right now into fundraising endeavours for my trip to Madagascar, as well as preparing for the Doula Training Intensive this summer. Preparing a training manual is no easy feat. So much of my writing energy is being used at the moment.
I had Friday off...meaning no clients, students to speak with, births, classes to teach, or school holidays at home with the kids. Of course, there was some administration to tend to, but I spent most of my day cleaning, laundering, and meal planning, and WOW is this weekend ever going smoothly! We woke up early and went out for groceries and a few anuals to fill in the garden as the perennials take up their rightful spaces in my young gardens. To not have a weekend spent mucking out a terribly neglected mess of a home is such a blessing! To not have to spend all Sunday doing the week's laundry makes me wonder at the possibilities of the day open to us tomorrow. I'm thinking of buying an apple tree to plant in my yard, and to finally get that last placenta out of the freezer and committing it to the earth. My little Finn is quite excited about the idea of planting his placenta. He is fascinated with his umbilical cord, and likes to look at it on occasion, but is fine with finally burying it.
We spent most of the day out and about and planting in the black and white garden, and will now cook a lovely dinner. A normal weekend like this is heavenly. I think I'm going to try to take every Friday off just to clean, prepare, and schedule. I turn on music and it doesn't even feel like a chore as the broom and I dance our way along. My daughter Oona cooked some lovely banana chocolate chip muffins for dessert. Maybe I will even just put up my feet and watch some hockey with my husband tonight. Or maybe a game of Trivial Pursuit with the kids. Or a walk to the lake with the dog. Ah, the evening is young. I will wait until the kids are in bed to do a bit of work.
I had Friday off...meaning no clients, students to speak with, births, classes to teach, or school holidays at home with the kids. Of course, there was some administration to tend to, but I spent most of my day cleaning, laundering, and meal planning, and WOW is this weekend ever going smoothly! We woke up early and went out for groceries and a few anuals to fill in the garden as the perennials take up their rightful spaces in my young gardens. To not have a weekend spent mucking out a terribly neglected mess of a home is such a blessing! To not have to spend all Sunday doing the week's laundry makes me wonder at the possibilities of the day open to us tomorrow. I'm thinking of buying an apple tree to plant in my yard, and to finally get that last placenta out of the freezer and committing it to the earth. My little Finn is quite excited about the idea of planting his placenta. He is fascinated with his umbilical cord, and likes to look at it on occasion, but is fine with finally burying it.
We spent most of the day out and about and planting in the black and white garden, and will now cook a lovely dinner. A normal weekend like this is heavenly. I think I'm going to try to take every Friday off just to clean, prepare, and schedule. I turn on music and it doesn't even feel like a chore as the broom and I dance our way along. My daughter Oona cooked some lovely banana chocolate chip muffins for dessert. Maybe I will even just put up my feet and watch some hockey with my husband tonight. Or maybe a game of Trivial Pursuit with the kids. Or a walk to the lake with the dog. Ah, the evening is young. I will wait until the kids are in bed to do a bit of work.
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