"Why Don't You Just Take the Epidural?"

Firstly, before anyone decides this is a rant against epidurals, let me explain. I am emphatically NOT anti-epidural. You cannot work in birth for nearly two decades and be anti-epidural. Just because I'm a doula, the very word conjuring up images of bowls of organic granola lovingly moistened by the milk of the goat who lives in my back yard, do not assume I am all about all natural birth all the time. Ultimately, I am about whatever works and women's choices. Just to be clear.

Before exploring some of the questions I've heard people ask in response to the shocking idea of natural birth, let me defend the poor old epidural for a moment. Everyone who has worked in a hospital birthing culture for a reasonable amount of time has seen how an epidural can potentially and sometimes even miraculously restore morale and labour efficiency to a woman who has been labouring hard for a long time with the discouraging news that she is not opening. We all have stories of women who stayed at home for a couple of days with contractions strong enough to make them vocalize loudly. You know, the kind that look like the baby should be coming soon but just isn't, so they decide at their limit to accept an epidural when they find out that the three centimetres dilated cervix their doctors told them they had 2 days before they even went into labour has not budged in the 72 hours of minute long contractions every few minutes they've been having. And then boom, she goes to 10cm in 30 minutes after a break in pain. Could it be there was a real physiological need for the epidural and its benefits of relaxation? Maybe. Could it have been a psychological thing? Perhaps. Could this be a product of our enculturation? Sure, why not? Regardless, it worked, and the baby came vaginally, an epidural being less of a risk and less of an invasive intervention than abdmonial surgery. So let us give credit where it is due and a round of applause to this brilliant invention that can and does help some mothers' births proceed a little more normally sometimes. Sure, most babies would come out given enough time. But in cases like that you might start to ask "at what cost?" Sometimes, one might need to admit that in the the odd case the benefit of an epidural outweighs the risks of a labour continuing the way it is. Sometimes no matter what stops the support team pulls out to help labour progress more normally, from emotional support to comfort measures, to maternal positioning, to bodywork, to homeopathy, to down and dirty emotional/spiritual excavation, our efforts do not magically produce a baby. Nobody is to blame. And you can look for the "whys" and "wherefores" all you want, but in that moment that's not necessarily the healing thing to do. In these cases, sometimes the epidural is the most compassionate and effective healing tool.

It is also important to emphasize that doulas are not anti-intervention, they are pro choice. If a woman is truly and fully informed of the risks and the benefits of routine epidural (those risks can be found within seconds on the internet for those not in the know) yet in spite of that knowledge still claims she will want an epidural because she knows herself and her relationship to pain, then it is not our business to judge her. Sometimes getting to the bottom of what is often fear helps her to move through that desire and she ends up birthing perfectly normally. Sometimes not. It is our job to support her with as much love and enthusiasm as someone going for those natural births we tend to like. It is simply not true that a woman will only choose a routine epidural out of ignorance and an unwillingness to let go of a sense of control and propriety. You still grunt, cry, bleed, and poop with an epidural...sometimes for longer than you would without it. Yet even when this is explained, some still want it. I tell women it is totally normal to bellow up a storm while in good labour, that of COURSE it's fine and even desireable to make some noise, as how would you and a baby, if you found yourself accidentally birthing in the forest, keep those blood thirsty carnivores away without your yells scaring the crap out of them? Even with that doula-logic instilled, some still want that epidural. Fair enough. Everyone has their reasons, and everyone deserves to have their decisions understood and respected when it comes to pain relief in labour. I do my best to educate, and if we want to remain in the spirit of true empowerment, we stand by the choices our clients make for their coping methods. Period.

So I just want to take a moment to explore the question, "Why don't you just take the epidural?"

Here are some of the thoughts I've heard people express on the subject.

1) "If there is all this pain relieving technology out there, why wouldn't you just take the epidural?" It is understandable that most people in our western birthing culture cannot understand why on earth a woman would want to go through that pain when they didn't have to. The spirit of this question is usually meant with compassion, an expression of curiosity around the idea of why one would choose to take the pain filled jourey of childbirth as opposed to the much more comfortable one.

This speaks to a fundamental lack of understanding of the benefits of natural childbirth. The pain is not just some inconvenient by-product of the process, it is what helps to conduct the flow of hormones. You contract, you hurt, you get more oxytocin, you hurt even more, and so on. If you're feeling okay and nobody is bugging you, this flow is usually not interrupted and the baby is born. If it is constantly interrupted by routines and a demand on the intellectual as opposed to mammalian part of your brain (like timing contractions, grrr, and strident heart monitoring protocols), things may feel more painful and be less effective. And the opposite can be true in some cases as well. Birth can be fickle and it can not give a crap about what's going on externally. It is too unpredictable to pin down. Contrary to popular belief, I have not seen this pain phenomenon make women automatically turn into crazed evil banshees, lashing out at their partners for ever having impregnated them. That's media education for you. For the most part, if the mother feels safe and well supported, I usually see the oxytocin make them behave very lovinginly and trustingly, and sweetly spoken. Even at 9cm of dilation, the vast majority of women are grasping me tightly, apologizing for possibly having hurt me, murmuring how glad they are I'm there, and I kid you not, I have even been told "I love you" on more numerous occasions than you would believe in such an intensely painful situation.

My neighbour has the mouth of truck driver, God love 'er. Her husband was terrified she would totally alienate the hospital staff when the pain of labour hit and made her start swearing a blue streak. Well, wouldn't you know, labour came, she did it naturally, and all her words were sweet and grateful. Not that labouring women don't let out a few choice curse words here and there...sure they do and that is fantastic. It's good to vent now and then. They get pissed off that the baby's not coming quickly enough or bummed out when someone is not doing what they need them to even though she has told them five times. But that brief annoyance is usually not directed at anybody in the anger you might expect of someone in a lot of pain. Put it this way, I have been hugged 99% more times than smacked while helping someone in labour, so, given the intensity of the sensation (been there, so I know what I'm talking about), you've got to figure the hormones must have some effect on that.

This oxytocin, when the baby and then placenta comes out, is as it's peak. The whole room seems jacked up to the hilt on the stuff. It's beautiful. When the baby arrives, usually most of the pain is gone immediately, relief sets in, and in a couple of days when the body memory fades, women say, "Oh my God, that was AMAZING! I would do that again." It is discombubulating if you're not aware of the beauty and power of natural birth, even when it looks INTENSE. You might think the mother is some kind of masochist given what you've just see her go through. But regardless, they usually do go on and do it naturally again if they've done it before. I have. Four times. In spite of the yelling and feeling like you'll never make it. In spite of sensation that makes you think you will never be able to contain it in one little body. In spite of the exhaustion, shaking, and nausea. In spite of the nine months of pregnancy challenges and discomforts. You most likely choose to do it that way again if it worked out for you before. And hey, even women who have had really tough, intervention filled experiences usually give birth again, many, even though they may have been those ones stuck for days at 3 cm with howler contractions and no progress, go into it the next time with the intent of doing it naturally.

So why do some women choose to do it naturally, whether they are first timers, have had a natural birth before, or have had terrible experiences before? It's not just because of the known health benefits of not messing with this particular blue print Nature has given to us if it's not warranted, but I guess because at the end of a good birthing journey, there's a body knowing, a deep soul intuition, a flash of motherwit if you will, that occurs when a birth has gone normally. It bestows upon your being a sense of rightness. In spite of all the judgements of "you're crazy." It just feels...right. It is what glory feels like. Labour is not something you love while you're doing it most of the time. You love it when it's done. It is at the same time the hardest and the best day of your life. Up and down, ebb and flow, effort and rest, give and take, scream and love.

2) "You wouldn't have root canal without anesthesia, would you? Why on earth would you have a baby without drugs if it hurts that much?"

This analogy bugs me to no end. It's stupid, even though it's asked if YOU'RE stupid. Sorry to those who like to use it. Root canal is a procedure dealing with a pathology. In your mouth. Someone is doing it to you to help you with something in you that is sick, impacted, and potentially rotten. If you want to put the intended nature of that question into its proper context, you should ask, "You wouldn't have a Cesarean without anesthesia, would you? So why would you have a vaginal birth naturally if it hurts so much?" But then you'd sound like a total tool, as the intention of Cesarean is to quickly remove a baby from a mother if one or both of them is in mortal danger (well, that's what it used to be for, anyway); normal vaginal birth is...well, normal, even with the level of pain usually involved.

Women have been birthing for a scabillion years. In fact, you, yes you, would not be here today if you did not come from ancestors who, from the beginning of time, birthed vaginally without epidurals. Even if your great grandmother and mother had a little help, or you were conceived in a petrie dish, it still means that (at least up 'til a couple of generations or so ago) you come from a line that can be drawn back to the dawn of birthing humanity in which they rocked birth old school. Yeah, we may have lost a mom here and there along the way. The benefit of living in the now is that maternal death happens less frequently in developed countries (though with all the stats on the impact of all this surgical birth on maternal health, even that is seeming sketchy). You may have lost a lot of great great great uncles and aunts over time. But you are here. How many births have occured in your ancestral line to get YOU here? Millions? Is this not a testament to the birth giving brilliance of your Grandmothers' bodies? And if you want to use the evolution/big fetal head argument on me, you're barking up the wrong tree. The poor old decrepit female pelvis is probably not to blame for what seems to be more difficult births and all these interventions to save us from the pain and death invading us from all sides. It's probably a combo of fear, enculturation, detachment from our bodies, sitting on our butts all the time, pain management messing with our hormones and muscles, birthing positions that are antithetical to simple mechanics, lack of real emotional support as everyone pays more attention to drama and danger, and a bunch of numerous other things I'll just get too mad about if I start writing about them now. The point of the whole "root canal/childbirth" analogy is that it needs to be put to rest because it is just an insult to one's intelligence and a spitting on the honour of our Grandmothers.

3) "Isn't wanting to give birth naturally just a display of feminine machismo?"

I have sat outside rooms beside a couple of male doctors, with the woman inside the room yelling and keening with her birthing pains, ask me that very question. I am not picking on male doctors, as I have known women to say this too...about other women. This feels even worse to me. Anyway, in these cases, I could sense the doctor was having a hard time not wanting to save the woman from what clearly sounded like abject suffering. The tension from hearing these sounds when there is a perfectly good Epidural Man walking around the hallways administering sweet pain relief can be a lot for many people, medical or otherwise, and they start to wonder as their stress builds, "well, if it really hurts that much, isn't kind of stupid to suffer like that? She can't give birth with all that tension. She's hurting herself and the baby. This is all ego based posturing so everyone can tell her what a hero she is afterwards." I invite those with this belief to reclaim their projections. Part of them is saying, "I want you to end your pain because I can't handle it." Trust me from many years of working with natural birth when I say that the most hard core natural birther will call for help when she has reached her limit. No thoughts of heroism intrude upon a woman who is in truly dysfunctional labour. It is obvious in one's deepest core that something isn't working that great. She stops being all trance-y and stoned with the contractions and the bad kind of adrenaline starts working, and she starts getting more intellectual about things. I myself have been in that space wondering, "hmmmm...I may need to think about plan B". We don't push ourselves to the limit or go about trying to prove a point at all cost. Nobody wants to put their babies or themselves at true risk. We push ourselves to the limit because we're handling it and we're strong, thank you very much.

Let us be clear about one thing. We as a culture use the phrase, "you don't have to be a hero" to women who state their intentions to have a natural birth. What we really mean is "don't be a martyr". A hero shines in beneficence and helps heal our world on various levels. Is it wrong to be a hero, for ourselves, for our babies? Is it wrong to want to create new legacies for our future birthing daughters and to embody the magnificence of normal birth to caregivers who rarely see it? Is it wrong to want to be a pioneer again? Is it wrong to want to reclaim a little faith in our bodies our culture views as defunct? Does that warrant this judgement of intended machoism? Is this how resentful people are of women who want to have natural births, that they will think them as megalomaniacs for going through the pain involved? If we were quiet about the pain would they feel differently? A martyr is someone who dies for her cause. I have never ever known a woman who would not throw herself on the floor and subject herself to unanesthetized surgery if there was evidence her baby was in immediate danger. This is not to say people don't sometimes make bad choices. It happens. But if we're talking about owning the sensations of labour, if a woman is paining, it doesn't mean she's dying, it means she is expressing a tremendous amount of raw, natural power. She is WORKING it. And if you can't stand the heat, you should get the hell out of the kitchen. When she's labouring she needs support and encouragement like the marathon runner who is at mile nineteen and all systems look to be shutting down. She doesn't need jugement about her intentions. Trust that if she can't take it or if there's danger, she'll do what she needs to do. That whole "feminist machismo" assumption is one of the most disempowering things I have ever heard, and it speaks of how little we regard the process that gets us here and those who have laboured to do so in heroic, miraculous grace. It speaks of a woman's intentions to experience birthing pain as misguided, and of not being smart enough and too stubborn to seek help when needed. Shame on us.

To be honest, there IS a tremendous ego boost to having birthed naturally. Huge. But it's a healthy one, not the macho kind. After that baby has come out naturally and you realize you did it all on your own steam you usually feel like a consummate badass. And is that so wrong? You haven't done it at anyone's expense, in fact, it has contributed to your and your baby's health. Shouldn't it be okay to feel great about that? In my doula logic I believe the confidence boost a woman receives from either having a great normal birth, or a difficult birth in which she may have needed interventions for but gave what she felt was her all, is one of the best springboards from which to leap into motherhood. Motherhood is joyful and amazing, but it's hard. And it's forever. To start out that relationship feeling like you can do anything, gives you RESOURCES. There is no Epidural Fairy who comes in the middle of the night to save your ass when your nipples hurt and the baby is waking up for the fifth time in a row. You are struggling, but you remember: you have given birth. You can do anything.

I ran into another neighbour of mine walking with her toddler and her new baby. Her first birth had been very long and she had had an epidural. She felt like she did great, but was a bit disappointed how it turned out. She wasn't sure she wanted to try it naturally again, but ended up doing so.

Lesley: "Jen, you had your baby! That's so great! How did it go?"

Jen (beaming): "I did it NATURALLY!"

Lesley: "Yay, that's fantastic, good for you! Do you feel like a rock star?"

Jen: "I AM a rock star. I feel like I could fly".

Enough said. "In glory and awe I have given birth, and found therein, my Self, my Child, and my God." -Kim Miller

Doula Work Hours : Finding Balance

Doulas are known to be extremely accommodating. We commit ourselves to staying at births no matter how long they are. That means slipping from our beds at 3am, without knowing as doctors, nurses, and many midwives do, when we will be home. If the birth is 3 hours, 30 hours, or 3 days, so be it. We are there. We quietly dip outside the birthing room with our cell phones when the sun rises and there is a lull in labour to reschedule our day packed with pre/post natals and re-arrange our childcare that becomes necessary after a couple of days away. Ah, there goes the day off planned for the week, and if the birth is really long, there goes the day off next week too in order to catch up on meetings. If the birth is super long and someone else went into labour early despite your attempts at good scheduling and you have to send a backup, well, there goes that income you had planned on too. It is crazy work, and it takes a very strong and giving spirit to do it happily without burnout. Thankfully, the rewards of birth attending are HUGE. I come home after a great birth or prenatal meeting high on good feelings of connection and the knowledge that I am doing something meaningful with my life.

The nature of a doula is usually one of givingness. To everyone. This can leave us sometimes feeling like we're failing everyone, our clients and our families, because we cannot clone ourselves and be fully present for all those people in our lives. It is extremely important, and you will see this as you grow into the work, that boundaries surrounding your pre/post natal meeting hours are essential.

I have kids in school. To see them off to school is important. To be there when they get home or soon after is important to me and to them. This is because usually at least once per week they miss me for a good chunk of time. Sometimes, like this week, there were three evenings in which I was there for neither after school nor bed time. This is hard on kids. It is crucial to find balance.

I schedule my meetings during school hours, from 10 to 3. This is not necessarily convenient for many clients who work, but as they usually take periods of time off once in a while to see their doctors or midwives, I usually suggest booking me in when they have that time off. I do not work (unless it's a birth or an event like a "Meet the Doula" night or apprentice gathering) evenings or weekends unless it is absolutely urgent. Sometimes I cave and meet with people at 9am or at 4pm. This is often NOT good for my family. I have to police myself firmly to not make that a habit. I arrived home at 3am one day this week, with a meeting scheduled at 9am. Constitutionally, I can stay up for 2 nights, down a coffee, and teach a 9 hour long doula training workshop without much issue. But it's not about me and keeping my schedule at this point. I realized if I made my 9am, which I should not have scheduled anyway, which I did out of guilt for not seeming accommodating enough to my beloved clients who work hard to schedule with me, that would be a LONG time away from my family. The after school, the dinner, the night time, AND the morning before school....for the second day in a row with many other births coming up, was getting a bit much. Those precious couple of hours to snuggle and catch up with our children, from toddlers to teens, are what nourish us all. We can go back to our work knowing everyone feels somewhat tended to if there is that reconnection to the home and hearth.

Another thing that makes not keeping schedules a total drag for my family is how hard my husband has to work to hold down the fort. He has his own stressful job. It's nine to five most of the time, but when you start feeling like a single dad of four, doing all the cooking, cleaning and child minding instead of his regular share so I can work, this can be a tremendous strain. He is the best doula husband ever. It is no easy feat being a doula's partner. His patience for my crazy birth attending hours has widened a lot over the years as he honours the importance of my job. But when it comes to sneaking in those little extra meeting hours in? No. Patience goes out the window, and I don't blame him. It's not only the days I'm not there, but if I arrive from a long birth at 8am, I usually need to sleep a bit, which means more time he is "on". He takes it in stride gracefully, and I am really grateful for that, but I totally understand why sneaking in those 4pm meetings, leaving supper to him AGAIN is a starting to ask a lot.

When we're starting out as doulas we're just so thrilled we get to go to births, and tend to bend over backwards to run any time and any place our clients want us to be so they are happy with us. As your practice grows, you will need to keep that in check and figure out what will work for your family and what will not. Yes, it is true, some clients may not hire you because they simply cannot make those day time meetings, but that's okay. I have a large enough practice that when one one client cannot take me, there are usually several more willing to take their place, and that will eventually happen for you to. There is a strength and grace and professionalism about someone who keeps strong boundaries. As doulas, we model mothering to our clients. To model the importance of family and boundaries is all part of the work.

And don't forget, there is not just work and family, there is you too. I always try to schedule a day off for my self during the week. I catch up on sleep, take long walks with the dog, go shopping, go for a long run along the lake shore, etc. It often doesn't work out because of births necessitating rescheduling of appointments, but when it does, I have to FIGHT the urge to sit down and work on administrative stuff or tend to all those little work-y things I "should" be doing. If I am going to model to my new mothers that self care is essential to harmonious parenting, and that they must "sleep when the baby sleeps" and not worry about messes and loose ends at work when there is a moment to chill out, I have to walk that walk too, otherwise my message is empty. I can only find true balance when my own self feels nourished enough to have plenty to give away.

As hard as it is finding balance as a doula, while I have my moments of stress and overwhelm, I do feel satisfied with most aspects of my life. I love my family and I love my work. And oh, I love my time to myself. If I don't get to be alone with my self or with my husband sometimes nothing runs as well. When guilt entered our culture for self-nourishment I'm not sure, but it is the ugly demon we need to keep fighting off in order live peaceful lives. Sitting in front of the tv in jammies on Sunday night is healing. Lying in bed reading a trashy novel when the house is a mess is a spiritual practice. Spontaneous kitchen messes with the kids are godly. Mother and work your heart out, sure, but have fun too.

A Rose by Any Other Name...Birth Speak

I have been noticing in the doula world some stuggles over words. We have so much to do, so many balances to create, so many environments to improve. Some of these struggles are completely spot on and need addressing. Some verge on what seem to be an attempt to be more unique or less mainstream than the average bear. Words most definitely have the power to make us distinct. Language is very important, no doubt. If I'm standing up strongly for myself and creating a stink over injustice, I don't like to be called a bitch. Calling someone "sweetheart" in a way that's clearly condescening and sexist, instead of in a loving, nurturing way is awful.

There is tremendous power in words and we do need to be careful. But sometimes quibbles can be much ado about nothing. Yes, apparently I am waxing Shakespearean this evening. I don't love the quibble over the word "contraction". Yes, while the endorphin suffused state of birth in no way feels emotionally like a contraction but an expansion of consciousness, in reality the uterus most certainly contracts. Hard. Calling it a wave or an energy rush is not a bad thing, but really, it doesn't change the fact that a uterine contraction is occuring. Calling it another name might make it seem less "hard" (I consider it to be a word referring more to simple mechanics than to Medicine) and perhaps more spiritual, (and in our culture this desire for a shift of balance in birth perception is certainly helpful for many), but I am perfectly comfortable with "contraction". The uterine contraction causes a heck of a lot of sensation, and while I understand this phenomenon is perhaps not what some people want to focus on in their birth experience, really, that big sensation which goes hand in hand with the mechanical uterine contractions seems to take center stage in most labours regardless of what we plan or hope for.

I have noticed that many people don't like to use the "p" word with regards to labour...you know what I'm talking about.....pain. There have been several terms generated to shift perception surrounding the birthing sensations, but in my humble experience both personal and in birth attending, I tend to believe birth hurts, no matter how you try to pretty up the word. But the pain isn't a bad thing. That strong, strong sensation creates the flow of endorphins, and our experience of it raises oxytocin levels so the next contraction is even STRONGER. We birth hopped up on that beautiful " 'ormone of luve", which is guided and driven by...you guessed it, pain. Whether they plan to or not, the vast majority of women feel some level of pain in labour. Instead of quibbling about the word, perhaps shifting the focus from the pain as being some nasty by-product of the childbearing process that we "shouldn't" have to suffer through to being a noble, healthy challenge we are absolutely capable of moving through would be more helpful. Call it an interesting sensation, call it a wave, sure...that doesn't hurt. But the sensation still does. And that's okay.

I see more and more doulas not seeming to like the word "training" for the process by which doulas learn their skills. The definition of training is: "organized activity aimed at imparting information and/or instructions to improve the recipient's performance or to help him or her attain a required level of knowledge or skill." I believe in training. Where I veer from most doula training organizations is that while I believe in good training including apprenticeship with an experienced doula, I don't care much about certification one way or another. In the doula world that piece of paper, while it is great because it means you did what was asked according to someone's made up standards, it in NO way means you're "done" learning. It in no way defines the greatness of a doula. Frankly, it means little to me. I have doulas on my team who are certified and who are not. What attracts me to them is their integrity, reliableness, passion, compassion, and a sense of knowledge I get from them just by speaking to them casually about birth. We develop through constant learning and continuing experience. So while the piece of paper stating "qualifications"is not so important to me, the fact they took the time to invest and immerse themselves into the preparation or "training" of how to be a doula is. There is a basic level of skill being a doula needs. I don't want to say "required" because that's too rigid. While the learning is life long, there are basics to know. You might want to know what a cervix is, for example. You need to know how to listen actively. You need to understand the process of labour and how women experience it. You need to know some tools to help. It's not all hearts and flowers and broadcasting love. So doula courses DO train doulas. Whether we want to claim that word "train"or not as what we do to prepare doulas is up to us, but I am happy with the word. I do not consider it too mainstream. I don't think it necessarily leads to an assumption of a means to an "end" of learning and major standard of pratice focus over skills. I don't believe it's about a check list of qualifications so you can call yourself a doula. It's about basic skills, information, and personal growth so that all participants can find their unique path and expression of the work. I'm sticking to the term "training" with impunity because I think it's a good word for the process of learning basic doula skills.

I'm not so down with the term "delivery" for the receiving of babies. What I don't like about it is that it implies the attendant "delivers" the baby. While they may be actively helping in some cases (whether it's needed in that situation or not), I've always kind of felt that mothers deliver their babies into the world. But I won't argue with or correct someone who uses this term.

You know what word I really don't like? "Doula"! It rubs me in all kinds of wrong ways. It comes from the Ancient Greek word "slave", for crying out loud! And a bonded slave at that. While the ancient lady of the house was birthing and mothering, her maidservant hung out with her and carried out a very noble role, but maybe not necessarily with the love and passion we modern doulas bring to our work because we do it from a place of free will and choice. To tend to women in their childbearing year is an honour. But the ancient maidservant was probably bought into the family and would have been stoned to death if she didn't carry out her role, like it or not. I can't think of one great other word describing what I do, but I must say it has never fell comfortably out of my mouth. Dooooouuuullllaaaaaa. It sounds kinda flakey to me..even a little romantic. Plus, half the people you mention it to say, "say what?" But hey, it is very deeply entrenched in our modern language, so instead of quibbling about it, I just go with it. It doesn't really change my life so much. Whether I'm called a doula or a birth attendant or an accompagnante, I love the role I play. A doula, the essence of the work being summed up by this popular word, is what I choose to call myself, whether I dig the acutal term or not. It's what people know and respond to. Really, "a rose by any other name would smell as sweet."

Lesley

Doulas Cannot Re-Create The Farm

I re-read Ina May's Guide to Childbirth, and have read Spiritual Midwifery at least 10 times over the last couple of decades. The message that always resonates most with me is that culture helps to shape birth. It is true to a large degree how something is observed influences how that thing functions or "behaves".

Ina May lives in a culture she has contributed to forming in which birth is a normal, natural, exciting, joyful, transition into motherhood...that women are powerful both in their birthing prowess and in the strength of the support they provide to the birthing women in their community. Her amazing stats bear this out, showing evidence for the efficacy of this woman centred rather than technological approach to birth. There is very little in the birth stories Ina May features in her books that cannot be remedied by the loving and strong support of the spiritual midwives and other women close to the couple. Of COURSE the unexpected and even the dangerous can and does happen on occasion, even on the Farm. But for the most part her statistics tell a much different story than standard North American birth stories, that many issues that come up in labour can be resolved with more emotional support and spiritual excavation rather than medical intervention (not eschewing, of course, good medical care when necessary). Again, bear in mind those phenomenal outcome stats before pooh poohing.

The birthing culture I live in now is way different. My "culture" when I was having my babies consisted of a community which favoured home birth, home schooling, natural approaches to health, bed sharing, etc.. The far reaching majority of us had pretty straightforward home births, easy breastfeeding, and good postpartum support from friends. I don't think any of us had Cesareans, whereas now you can't throw a stick without hitting someone who's given birth surgically. What used to be considered a major thing is now becoming a norm. We held Blessingway ceremonies for each other during pregnancy and hung out a lot telling good birth stories and providing each other with emotional support. It was a beautiful time. Now these children we birthed and nourished are growing fast, many of them already grown. I pray our practices stick with them as they make their way through the ups and downs of today's North American birth culture.

It has been said that form follows function and function follows form. As above, so below. When our culture has such an overwhelming fear of the birth process, it makes sense this seems to be reflected in our birth outcome statistics. For all our shiny technology, our outcomes are pretty poor compared to Ina May's at the Farm. So many births seem to need epidurals and Cesareans despite the woman's best intentions. Women are told they couldn't have had a safe birth without their interventions. The poor old female pelvis is not the all powerful thing we seem to pay lip service to after viewing all those great birth documentaries, but apparently, according to our North American stats, an unpredictable lemon. When it works naturally, it's an awe and triumph, not really the norm. A natural birth is a rarity. In fact, in our present birth culture, natural birth is often seen as radical, sometimes even held in contempt not just by some of the medical community, but by many of the women themselves. This breaks my heart as it demonstrates a terrible collective misguidedness.

The way we prepare women for birth is so intellectual. Breathing techniques often consist of counting. Women seek to hypnotize themselves out of a fear response to the normal sensations of birth! I see women reading all the right books and wanting the image of that dream birth yet still buying the cultural fear so much that they will almost always in the end go for that 41 week induction for terror of sudden fetal death, or go to that hospital with 24 hour on call anesthesia just in case they can't handle it, but without exploring what "can't handle it" means. They get mad at their doctors sometimes for delivering the information and treatment outlines to them (and I don't blame them much of the time, as this information can sometimes be delivered in ways that make them feel like bad, neglectful parents if they don't do what they're told). In the end though, nobody goes to their houses, holds their faith in their bodies hostage, and takes them at gunpoint off to their intervention filled births. We must recognize that there is some choice here, and that we must own for the most part that which we make informed choices about. These choices shape our culture.

It is a hard thing for women in this culture to bear, and one that I believe to very much affect the mechanics and juicy hormones of birth: on the one hand you want a great natural birth inspired by the good stories and films out there, but on the other you ultimately feel you must trust Medicine as the last word and a very fear based aggressive approach, feeling backed into a corner and possibly resentful, yet unwilling (or in many cases unable due to lack of resources) to make different choices because of...you guessed it...the very fear that makes Medicine outline those choices. We are terrified of the unknown and for being responsible for choosing something that may ultimately make us suffer the horror of having hurt our babies. Medicine is afraid of the repercussion of uncontrolled choice as much as we are....thus everyone feeds off the fear and it continues to spiral out of control, to the extent that in some North American hospitals the Cesarean rate is over 50%. We keep choosing the more medical approach DESPITE the rather grim statistics (ie.: definitely not like Ina May's)which seem to illustrate that the more we mess with normal birth the more problems we seem to cause. YES, Medicine saves lives, and God bless it! YES, sometimes things happen out of the blue that necessitate quick and immediate medical care. And for that reason, though those quick emergencies are pretty rare (I sound like a broken record, but I again defer to Ina May's gorgeous stats), we continue to take calculated, controlled risks to our normal births, very likely causing more problems than would need to be treated if we didn't interfere so much with this process.

It is very hard to bring the Ina May approach into the hospital. Her approach is about trusting ourselves, the process, and the support. Her brand of midwifery is certainly wise and vigilant (again, check out the great birth outcomes), but it is dynamic and views the woman as a whole, not a check mark on the all mighty progress chart or an alarm bell going off when anything is not "average". Not that doctors are uncompassionate and uncaring...on the contrary, their choices are usually motivated by a lot of care. Ultimately, though, clinical responsibility and covering all contingencies is the absolute priority. That's the way it is. The Farm midwives know the relationship of the couple, know who's visiting whose hut, know the diet well....our doctors are not aware of these factors and cannot offer support that way. They are busy preventing and treating the many emergencies, which is not a bad thing.

So where do we find balance? While a doula certainly provides the loving, guiding aspect of support the Farm midwives do, we usually do so in the hospital. This is not the lovely home environment of Ina May's birth stories our clients read about and are inspired by. Instead, their births unfold in an environment that is saturated with the fear of all the bad things that can happen, the fear of not making all the right choices to save a baby's life, and an endless sea of strange faces coming and going and commenting. Having a doula present doesn't magically erase the heaviness of this environment. Surely we help. It is true our clients have less Cesareans and epidurals, but to believe their births will be like the ones on the Farm with the support of a doula within the hospital environment is simply not true. Doula or not, the pervading institutional-ness of the hospital will have a profound effect upon more sensitive physiologies, potentially creating in the end what will be a real need for interventions.

A doula's emotional support is powerful, it is true, and can reduce anxiety thus a need for many interventions, but our support can easily be undone by many different things....a shift change, another bit of information about the labour that requires a mom to be on a monitor more and frightened, an insensitive vaginal exam... A sensitive woman will definitely be thrown by a well meaning but misplaced comment or harsh word no matter the buffering power of her doula's word medicine.

I have seen the environment shut down a great labour despite my attempts, and this can make us feel really powerless sometimes. Sure, sometimes you are very grateful as a doula you were at the hospital because of a truly unforseen emergency. But often you have a sneaking suspicion that a little privacy and a little time off the monitor would have turned a "stalled" labour around instead of the epidural that was sold so hard you're all left reeling. And even though the labouring woman knows this on one level, fear of not doing what's suggested often bears out and influences her choices...which influences her labour....which co creates the bigger picture of our birth culture.

Luckily, we doulas have FAR more great stories than not, but let's face it....the books we write will never be like the stories they have on the Farm unless we live in a homebirthing culture. Yet we keep on slogging, praying that each great birth we attend contributes to a healing of this culture and the slow, slow swinging of the pendulum. For now, I seek to make hospital birth, which is the norm no matter what I have to say about it, as humane and as beautiful as I possibly can. If I didn't see great success with that much of the time, I couldn't continue doing this work. I would be walking around permanently wounded. So doulas, especially newer doulas who have been having their eyes opened to the reality of hospital birth despite their hopes and best intentions, though it sometimes seems overwhelming and impossible, don't give up. We are making a difference.

Lesley Everest

www.MotherWit.ca

Doula Training in Nova Scotia

It is official! MotherWit is hitting the East Coast of Canada this summer. Join the Doula Ceilidh from July 24th to July 29th as we get down to the nitty gritty, the earthy crunchy, and even the airy fairy of the science and art of being a doula.

This full six day/3 evening birth doula training intensive will take place at the beautiful WindHorse Farm in New Germany, Nova Scotia (windhorsefarm.org), which is about a 90 minute drive from Halifax and 30 minute drive from Lunenburg (home of the Bluenose). We are renting the Sunshine/Carriage House which will hold our hostess (Katrina of Cape Breton) and 15 live-in students (though our training will not be limited to 15 for those who wish not to stay in the house).

Our unique intensive approach is geared to eating, breathing, and sleeping birth. Our training last summer in Morin Heights, Quebec among the beautiful scenery of the Laurentian hills and living in close quarters for nearly a week created a life changing experience for many of the women who attended. In this tradition, we bring our training to you doula sisters and doula wanna be's out east.

This course in holistic birth doula work is great for those who desire to serve their community as doulas, for those wanting to go on to study midwifery or nursing, for those wishing to expand their knowledge of tending to women in their childbearing year, or for more experienced doulas who wish to deepen their knowledge and wisdom. There are no prerequisites except a desire to nurture, educate, and support families during this special time in their lives. A doula has the potential to bring profound healing to a wounded birth culture with each family she serves. Evidence supports the fact that the presence of a doula in the birthing room reduces the risk of unnecessary interventions (as well as potentially mitigating the risks of those that could become necessary), and this training will show you how to do it.

We will talk about the tools women have used to help promote balance and healing since women have been birthing, as well as explore in detail how to create and hold the space conducive to normal, triumphant childbirth in different settings, as well learn how to support those having more challenging or even traumatic births. Learning how to deal with difficult situations and how to tend to ourselves as doulas is also emphasised in this course. Nestled within the shelter of Windhorse Farm and supported by the magical beauty of Nova Scotia, join us on this journey.

Women from Prince Edward Island, New Brunswick, and Newfoundland, it would be such an honour to have you. We realize doula training may be difficult to find in your areas, so this would be a perfect opportunity to learn to start generating crucial change to the birth culture in your town. It really doesn't matter where you're from. If you've always wanted to visit Nova Scotia, here's a great reason to do it.

Join me and my teaching assistant Sesch Wren for a week you'll never forget!

Details will be put up on http://www.motherwit.ca/ soon.

For you ladies farther out West, you are not forgotten! The amazing Tracey from Birth Source Inc. (http://www.birthsource.ca/) and I have been having some very interesting chats about bringing this new approach to doula training to Edmonton. We are also discussing bringing the MotherWit Doula Mentor Training to Edmonton as well, which is intended for experienced doulas (certification not necessary) who have a strong desire to reignite the ancient approach of taking apprentices, which is ultimately the very best way to learn how to be a doula: from other experienced doulas. No dates have been set yet and we're still in the planning phase, but just so you know we're thinking of you.

And for you ladies across the pond, the sweet Rebecca Wright (http://www.durhamdoulas.com/) and I have been doing some planning of a birth doula training intensive for UK doula sisters, as well as the mentorship workshop for experienced doulas. Irish, Scottish, Welsh and English doulas/doula wanna be's, keep checking back for more information as our plans develop.

If you're from anywhere else and are wishing so much you could join us but just can't because of distance, consider hosting us. We LOVE to travel.

Positions in Labour

When I meet people who are interested in working with me as a doula or childbirth educator, one of their burning questions is: "Are you going to teach me about positions to use in labour to make me more comfortable?"



While I may do the briefest of overviews to show what many women enjoy doing positionally with their contractions, asking them and their partners to try them out so they can feel comfortable knowing what they are doing is totally normal once they're in labour, positions for comfort is actually something I don't focus on a lot. I tend to find most women know what to do in normal, ummedicated, physiological labour to make their contractions more efficient and comfortable. If we provide fancy charts of positions that are helpful to birthing women, it assumes they will be using their intellect during labour to mentally bring up the image of the "menu" of positions (or check their notes while actually in labour), and select which might work for their particular scenario. While this may help in early labour (or not, as I tend to recommend the "don't focus on early labour and find something to distract yourself with" approach rather than the "focus on the early sensations with all kinds of positioning and massage so you're at a loss as to what to use to help when things really get cooking" approach), the kinds of contractions that have you drifting away on an endorphin cloud to lala land are simply not conducive to the mental gymnastics of cross referencing.

I have actually not seen a labouring woman with back pain NOT lean over or go on her hands and knees to take that desperate pressure off her sacrum. I often see women who are being monitored while lying on a bed rip off the transducers and stand up because they simply cannot lie there any longer. They can't tell you why, they just know they cannot bear that position anymore. Their bodies are guiding them intuitively, their babies whispering from the inside, "Mama, I need some more space...move this way."

I have had women yell in transition, "Tell me what to do! What do I do?!" and I'll make a suggestion, but inevitably they do what they want. I remember a woman asking her midwife what to do and the midwife suggested she sit on the toilet. It's a great suggestion...the opening of the legs, the safety of the toilet, the squatting position putting pressure of the baby's head on the stretchy cervix, helping it to open perhaps more quickly. There's no need to explain all of that to the labouring mom , as it's too much information for her to process. All she wants is some direction on which to anchor her hopes that this will all be over soon. Despite the midwife's simple suggestion, the mom just stood over the toilet. All she wanted to do was stand, so finally after being asked several times what she should do, the midwife validated that clearly what this woman wanted to do was stand, and to trust that. When she started grasping and pulling down on the shower rod, we guided her out of the bath (where she was standing) so she could grab onto the trapeze bar provided for that purpose. She birthed beautifully hanging from the bar. That would have happened whether she had been educated about positions in advance or not.

Labouring mothers often do some strange things to comfort themselves in labour, and it's all good. I've seen women lie down on the bare hospital floor because it felt cool, stand up on a chair because the floor felt too hard, or walk like an elephant on all fours swaying to and fro with their heads. All a mom needs to know is that if it feels good, she can go for it.

Where positioning education comes in very handy is when the mother has an epidural. Because many of her body instincts are numbed by the medications and positioning of the baby can become misaligned with the pelvic structure, suggestions of position changes help a lot. And because the mother is capable with the reduction or absense of pain and endorphins to draw upon her intellectual capacities, a check list she's learned in advance of positions to increase labour's efficacy can be extremely useful if she doesn't have anyone around to guide her with this.

When labour is NOT going normally and clearly the baby needs to do some shifting to create a better fit with Mom's pelvis, positioning can be extremely helpful. I had a mom once whose back was so sore and stiff from a long hard labour that she couldn't sit down. She wanted to, but the aching prevented her from acting out her intuition. Her husband and I tried to guide her to sit on the toilet, but she just couldn't bend her knees. Her poor back was raw from all our rubbing. Her poor bum muscles were so tight from all the pain, so my instinct was to grab them and shake them out. I did this for a good minute, just jiggling those bum cheeks. We were all giggling a little. Finally the mom sat down, and things got moving immediately. She ran to the bed, got on all fours, and was found to be fully dilated. Again, we could teach all that in childbirth ed, but really, when in the throes of labour, without some skilled direction, she and her stressed out partner probably won't think about all the possibilities or receive support. This is why good childbirth education AND good doula support create better outcomes than just education.

Positions for rest are something I like to talk about. Sometimes moms get really tired, but cannot stay in a position during contractions that they really like between them. So knowing how to rest and contract in one position for a bit while she regains her energy is useful. I like using a yoga ball and edge of a bed or counter to lean over on for resting and contracting, or hanging out in the bath. It's important that the skill of how to rest and chill out in labour is as important as riding the waves of contractions.

Another area in which discussiong positions is useful is when it comes to the second stage of labour. I love to watch people's faces as I demonstrate what a normal labouring woman often loves to do when that fetal ejection reflex kicks in...butt juts outward, arms reach up to grasp, torso leans way forward. I gently and slowly tip myself backwards without moving any limbs, just letting my hands grasp my knees, and it really hits home how, when you adopt the stranded beetle position, a woman is asked to do the EXACT opposite in most OB assisted births of what Nature asks, effectively mobilizing the sacrum (which dearly wants to be able to stretch and yield to the babe's extending head), perhaps necessitating circus style pushing to compensate for the smaller space created in the pelvis, and potentially wreaking all kinds of nasty havoc. Telling women that there is a good possibility of their not feeling great being on their backs while pushing (as many don't know this is not the real "way" the body likes to deliver babies), and that their instincts to do otherwise are spot on regardless of what they're directed, helps them to know they're not "bad" patients or somehow abnormal. And it's also helpful for them to know that there is no black and white, and that if they do happen to feel good on their backs, then this is absolutely fine too. Just because it may not be an ideal position for some, it may certainly be for others. I have seen women whose babies are exiting with great speed (myself included) throw themselves spontaneously on their backs. Perhaps this is how we are intuively guided to slow things down a little.

It is important to remember that birth is not intellectual from the birthing woman's point of view. The more charts and diagrams a woman has to look at and follow, the more she gets caught in wondering, "okay at what point do I do this, what sensation necessitates this position, etc." This is exactly where we do NOT want labouring ladies to be...in their heads worrying about what is "right". If they seem as happy as they can be in super active labour and things are going well, then it's right. The most useful tools in childbirth education are not the fancy tricks that are learned involving balls and positions, but the practice of relaxation, release of tension through whatever means the mother prefers, and the ability to stay with the sensations confidently as opposed to reacting to them with fear.

A Guide to Holding Birth Trauma

Scary things can happen in birth sometimes. It's not something we like to think about, but the fear of emergencies in birth is something that lurks in the corners of the minds of pregnant women and their caregivers alike.

As doulas, occasionally we are front row centre witnesses for someones trauma. It can feel powerless watching those scary things unfold. We are often grasping at straws in our minds wondering, "What do I do? How can I help fix this?" Well, sometimes we can't. As much as we try to prevent birth trauma by guiding people to empowered choices and as much as we hate for bad things to happen to the couples in our care, the unexpected can occur. We can end up feeling very powerless when an emergency takes place, and it's crucial to know how to anchor ourselves in the eye of the hurricane so as to create the optimal space for healing to begin as soon as possible.

While trauma is occurring:

1) Acknowledge it. We need to look those parents deeply in the eyes, take a breath, and in our own gentle, loving way say, "Yeah. Here we are. That scary place nobody ever wants to go. Breathe, and hold on.". Trying to "make it pretty" when the proverbial poop is hitting the fan, minimizies the experience and only leads to dissociation.

2) Stay present. Breaking down emotionally, getting caught up in those bubbles of fear and drama, and freezing up is not an option. You cannot "check out". You need to open your heart up, waaaayyy up, stay anchored within the chaos, and stay there strongly with your clients. Be totally present, surrounding them with as much love and calm coming out of that open heart space as possible. It may sound flaky, but the emotional tone we set can have the power to keep others calm. As doulas are very much "space holders", what we energetically broadcast into the room can influence how the parents and caregivers respond to the trauma.

3) Reassure when possible. If a woman has to go through a tough obstetric procedure, while we can't make it rosy, we can definitely let her and her partner know all the positive aspects of what is happening, like "You are doing GREAT!", "We can see your baby now, hang on!", "This is the hardest part and it's almost finished." If Baby is an issue, repeating the positive things you hear the caregivers saying can be helpful to parents, such as, "They say your baby's heart rate sounds great." or "Her breathing has improved a lot in the last minute." A blue floppy baby is all a parent will see, and if it is appropriate, letting them know the good stuff that is going on with their newborn while the caregivers are busy focusing on their tiny patient can help promote calm. Often, parents will not receive this information, and their terror of the unknown could otherwise exacerbate their sense of trauma surrounding the memory of their child's first moments of life. Being informed and reassured whenever possible is comforting to parents. The look on the faces of new parents when nobody is actually telling them the baby is breathing with a good heart rate is enough to ensure you as a doula are on top of this.

4) Be loving. Touch the mom, speak to her lovingly, stroke her hair, coo to her. Be loving to her partner. This helps to promote oxytocin and reduce too much adrenaline response. Doing whatever you can to keep that mother/baby hormonal connection intact, even when the baby needs to make a fast birth exit or has just had a difficult passage and is not able to be in the room with her, may help improve her future memory of her birth experience.

5) Trust. Give caregivers ample room and support in their important job of dealing with a medical emergency. Trusting doesn't create the outcome we want, but staying connected to the trust whenever possible that everyone is doing their best, promotes calm, often helping the best care come about. As doulas, our spiritual beliefs are definitely something to draw from at this time, if we are so inclined. The idea of trusting that as we hold the space for our clients and everyone else in the room, all of us are also being held by a loving source, even if what's happening is something we can't make sense of, is something many doulas and caregivers seek comfort in. Knowing deeply we have no ultimate control and that our power lies simply in doing the tasks required, being present, and living this moment as fully as possible, no matter what, is often what helps us all to heal more completely when the emergency is over.

Once trauma has occurred and everyone is left picking up the pieces:

6) Beware of magical thinking. I had a sweet, lovely student end up attending several dramatic C-sections for her first mentored births. After the third, she broke down in sobs, asking, "Is it ME?" The doctor present was loving but firm and gave her a great reality check: "Ah, Sweetheart, you feel like you've earned the black crow award because all you've been present for so far is emergencies. We can all feel like this. Really, though, you're not THAT powerful that you can bring on bad outcomes just by your presence." This is a wise and straight to the point wake up call on those days we are stuck in the past traumatic experience, trying to envision what a different outcome might have been had we heroically jumped in to do the impossible to spare a woman from turmoil. Know what to own, know what to let go of as magical thinking. Help your client avoid falling into this trap too.

7) Don't entertain the "why" and "what if" too much beyond getting to the basic physical reasons something may have happened. Spending hours conjecturing "why" is not healthy, and with doulas/caregivers sometimes even arrogant as we try to throw out many hypotheses that will usually only ever remain hypotheses. It soothes our egos to have a tangible reason for those unexplained traumas, but healing isn't about soothing our egos. Sometimes things are just mysteries, and what's done is done. Sure, when there is evidence for something, it can feel good to know actions were completely justified. However, often there are many pieces of the puzzle missing, and will always be missing. An amazingly wise Abenaki Grandmother told me once, "Every time you ask why, Spirit takes a step back. Who says you get to be privy to why something happens the way it does? Instead, ask, 'What is it I can learn from this experience? Spirit will take a step forward.'"

Many clients after trauma will ask if you think the outcome could have been different had they done something else, for example, let's say, birthed vaginally had they avoided the epidural. You cannot possibly answer this question. Gently point out that wallowing in the whys and what ifs are fodder for self flagellation, and not healing. Embracing the experience for whatever it was, good or bad, making meaning of it, and living fully is usually a better choice for healing. This may only come about after a long period of grieving.

8) Debrief with your clients about their experience. Let them pour out their pain without trying to pretty the experience up for them. Don't join the ranks who say, "Well, at least you have a healthy baby." (if the baby is indeed healthy). Women need to feel "allowed" to grieve the loss of the experience they wanted. It's not selfish to have hoped for a lovely birth. It is heartbreaking to have suffered trauma. Grief is totally appropriate. My dear friend says when something has gone badly, "Dude, that sucks." She says it with absolute compassion, and there is comfort in knowing that someone acknowledges that something plainly sucked as opposed to having someone be chirpy and sunshiny when the real emotional landscape is so obviously grey. We want people we care about so much to feel better, but it's not always possible for a while. Sparing someone from authentic feelings and creating dissociation by interjecting niceties is more about our being uncomfortable with their feelings, and it's the same pattern that contributes to such high epidural rates, "Oh, poor dear, you're suffering. I can't stand to see you in pain. Let's just make it go away."

When the whole thing is talked out and there is more emotional space for perspective, connect them to where they were amazing and graceful in dealing with such challenging circumstances. It's not the same as trying to make it pretty. It's honouring the person's role in authentic and powerful living. They may have felt totally "weak" because they cried and couldn't "get on top" of things. Crying and feeling scared is emphatically NOT weakness. Just as the icon of the Zen woman breathing easily and painlessly through her contractions is not an appropriate image of birthing, neither is the stoic stiff upper lip image for someone who is softer and more sensitive.
Deeply honour how a couple moves through the unique emotional terrain of their unique births.

9) Provide resources. If couples need to seek more counseling about birth trauma or reactions of anxiety and/or depression, knowing which professional avenues to send them down is important. Be very aware of your limitations. Doulas are not therapists, and owning all of your client's emotional process is not appropriate, potentially blocking their healing by not sending them to the proper resources. You can always be available for support, but support doesn't mean owning their healing.

10) Doula heal your Self. When you have been traumatized, it is your mandate to deal with it. You cannot bring past trauma to the next birth and be fully present for the clients in your care. Doulas can and most certainly do experience Post Tramatic Stress Syndrome, whether it be from a true birth emergency to witnessing violently harmful and disrespectful behaviour towards a client. Whatever the reason, it is our responsibility to take the time we need to heal. Write it out. Connect with your own spiritual practices. CALL YOUR SISTERS! A community of doulas is the best way to help each other heal. I'm all about doula-ing the doula and without the support I receive from my community, I would most likely be a gibbering mess today. Reach out, talk it out, and embrace the incredible richness of this life of birth attending. Connect, ultimately, with your Love, as this is what grows when we remain present and seek to heal our own wounds. This Love can serve as a light to those healing their own traumas.

MotherWit Birth Doula Training Begins Soon!

I am so excited to be welcoming the new wave of doula students who will be embarking upon this journey with me on February 17th, 18th, 19th, and 20th, and March 17th, 18th, 19th, and 20th.

This is a bit of a new format. Our last training was in the beautiful hills of Morin Heights where we connected to Nature and lived/breathed/ate/slept Birth for six incredibly intense days and nights. This format suits those who cannot leave the city for that long, and who like to take things a little slower, having a month's break to process learnings before moving on to studying how to hold the more challenging aspects of birth and hospital environment. I will still do intensives for any group of doulas who wish anywhere in the world, but the Montreal training will be a more leisurely format this year.

Apprenticeships are wrapping up from the last training...we have established regular case study/doula support nights, the students are well connected, providing support and guidance for each other, creating and nourishing the community of birth healers I have been wishing to see for years. Many are almost finished their training requirements and soon we will have more well prepared doulas out in the world who have been guided and mentored. This is the core of doula work: woman to woman support, birth attendants healing themselves, an ability for doulas to not only know how to help on a factual level, but to intuit, guide, and offer wisdom. I am so deeply proud of my trainees, as they slowly make their transition from apprentices to colleagues, adding their voices, their stories, and their skills to those of the many visionaries we need to bring this birth culture, which has spiraled outwards in its insanity, back to where it belongs...into the hands of the family....at its very root a transitional journey ripe with potential for healing. It is an honour to embrace these women as sisters.

I open my arms to all of you, new MotherWittie novices, and am so glad to have the opportunity to teach you some of the things I know. We are going to have fun, you are going to experience challenge, and you will find healing and growth. Thanks so much for joining us, and I'll see you in a few days!


Lesley

A Doula's Path

"Doula" is not yet a common household word, though the importance of the role of a doula in modern maternity care is well documented in many studies. For those of you new to the concept, a doula is a woman who supports pregnant, birthing, and postpartum women and their families. The word is derived from the ancient Greek word for "slave" (I know, strange, right?), but has come to mean "in the service of women" in modern times. A doula supports women in their childbearing year by providing information about what she's going through and the choices she will face as pregnancy, birth, and mothering unfolds, offers comfort measures to ease the bumps along the journey, as well as reassures with constant emotional support.

If the mother has a partner, he or she also benefits from a doula's care, as the doula's support extends to them as well, ensuring they are well informed, prepared, and relieved of the stressful feelings many duties required of birth partners evoke. Many things concern the birth partner, such as knowing whether what the mother is experiencing is normal or not (if someone has never seen birth before, it may not be obvious that shaking, vomiting, and loud vocalizations are all very typical things labouring ladies do), having to press hospital staff for clarification surrounding medical interventions in birth, knowing what best techniques and methods to use to help the mother cope with the strong sensations and emotions that come up in birth, knowing how to deal with sore nipples during breastfeeding, etc....the list is vast. By being free of the burden of anxiety of having to know all the details of birth and how to advocate for the mother and help her deal with the challenging task of birth, not to mention at the same time being an emotionally invested, possibly nervous partner and co-parent, the partner can be fully present for the mother, holding her, encouraging her, and providing the intimate connection which gives so many women the strength they need to get the hard job of birthing done.

A question that commonly comes up is, "Is a doula the same as a midwife?" The answer to that is "no". Midwives, while also usually extremely supportive to the couple in their childbearing year, also usually have the responsibility of the mother's clinical care, meaning the midwife is the one who assesses and monitors the mother and baby's health throughout pregnancy and birth as well as the weeks following birth. She is usually a primary caregiver, and depending upon the laws of the country, province,state or county the midwife lives in, she "delivers" babies in a home, hospital, or birthing centre setting.

A doula's care is not clinical. Some doulas have midwifery skills, and if this is the case, they often, if where they live allows, work as "monitrices", meaning they provide the support of a doula, but monitor the mother's and baby's health at home until she feels it is time to move to the hospital for a doctor or midwife to take over clinical responsibility of the birth while she stays to support the couple. Because a doula is not responsible for a woman's or baby's health status, she is free to provide that information, comfort, and support the couple wants. That nuance was really brought home to me during the birth of my first child. My midwife arrived at my home when I felt like labour was good and strong. She listened to the baby's heart through my belly and examined my cervix. She said, "Everything is good. I'm going to go take my sleeping bag and have a nap in the other room so I can be fresh when the baby is born. My assistant will stay with you." I didn't know the assistant well, though she was very nice. She was not, however, particularly skilled at providing comfort or emotional support, and didn't really address my inexperienced anxiety at having dilated from 3 to only 4 centimetres in 18 hours of labour. It was my doula and my husband who kept me grounded and provided me with immense comfort, like massage for my sore back, whispered sweet nothings, and a real sense of emotional safety. Not that a midwife can't or doesn't do that very same thing, it's just that in my case, she was tired from having attended a lot of births, and was doing the responsible thing by ensuring she was fresh and awake when I gave birth so she could better use her clinical skills if they became necessary. When primary caregivers and doulas work together, the couple often feel they are getting the best of care, meaning a good clinical safety net should it become necessary, as well as continual supportive care.

I have been a doula in Montreal for over 17 years now. I have often been asked why I don't go on to become a midwife or a doctor. For one, I enjoy being "just" a doula. I am personally not interested in being responsible for important health decisions should they arise. I have much respect for those who are, and I prefer to let them do their thing while I remain continually emotionally present for pregnant, birthing, and postpartum women. If things go unexpectedly in birth, then clinical care is the priority of the primary caregiver, whereas the doula takes those scared parents-to-be by the hand, looks deeply into their eyes, weaves a web of calm around them and says, "Okay. Here we are..yes, in that very place you were scared to be. Breathe and stay." If things go normally, as they usually do, we simply remain available for what the parents need for comfort.

My favourite thing about being a doula is being a keeper of precious memories for parents, of moments of their love and brilliance told to them later on in our postpartum follow up visits. To witness a new father moments after birth as he anoints his baby with his tears of awe, or to hear those quiet, holy words of love whispered to a newborn by his enraptured mother is to hold the most beautiful and subtle threads of the tapestry of the story of this family's beginning, threads that are lovingly handed to them in the moments the parents are swept away on the roller coaster ride of the postpartum period. These bits of story connect them to their strength, serving as reminders that all of this experience, even the hard parts, is about love. The healing potential in these juicy bits of story could be so easily missed if we as doulas had to put our attention to the clinical details. We walk the halls with our couples while they labour, sit by them while they rest in the bathtub, just listening...with our ears, with our hearts, always striving to find the balance between being and doing.

As we are story keepers, so are we keepers of the gate between fear and confidence, distress and courage, panic and calm, empowerment and victimization. While we do not own the birth our clients experience, nor attempt to control birth or birth's caregivers, our belief in birth as a sacred journey, no matter how it unfolds, very much holds the potential to influence the process. Doulas strive at births to be our most grounded in the knowledge we have as well as open to the realms of intuition, which we look to when we need to know the best way to buffer a harsh environment, or to sooth away the ripples caused by an unconscious yet hurtful remark, so things that could otherwise potentially be perceived as trauma do not get a chance to anchor into the labouring woman's perception and be carried into motherhood with her. It is not always possible, but we try our best.

As a young doula I wanted to help women have natural births, no matter what. I felt like the epidural and I were in competition. I was easily wounded by the often shocking hospital environment, and felt like if a woman received an intervention, I had failed. It took time and experience to know on a cellular level that my job was not to rue every little intervention. I don't own another woman's birth. She is responsible for her choices. If she decides she must give birth in a hospital to feel safe, she will be subject to the environment. I do my best to buffer the harshness of the hospital environment and empower her as best I can so she is able to make choices suitable to her. If she chooses induction because she and her doctor feel this is best, it is not my business or my right to dissuade her. I ensure she has the best information I can give her at her fingertips with which to make an informed choice, and when she chooses, I support. Yeah, that ride may potentially prove to be really bumpy as all those risks she was hoping to avoid with induction become reality in her experience. And so it is. This is her story, her learning, and her own grappling with the tension that lies between trust in her body and fear of not doing the right thing for her baby. I have learned that my job is to support not always what I wish would be for someone, but what exists in the now.

I know many have contempt for doulas...the Medical Establishment (and I refer to an entity, not to individuals, whom I find are most often caring and have the best interest of the mother and baby at heart) for our illuminating the often gross shortcomings in the sometimes unconscious and unkind policies that are not at all supportive of a labouring woman, her baby, and her partner. There are as well those who think doulas are sell outs by trying to help women have more humane birth experiences within the hospital system, standing idly by as we meekly "allow" our clients to be brutalized. Again, I support what is, not just what I wish would be. Sure, I'd love us all to claim responsibility for our own births, birth at home humanely and lovingly, our experiences undisturbed, our babies born into optimal bonding environments with bodies, minds, and spirits intact. I am blessed to have had that experience three out of four times, and I want that as much for everyone as the next guy does. But if about 98% of women in North America are giving birth in the hospital, most with medical care, because they feel safe there or they feel it's the only option they have, this sense of safety and lack of options a product of a culture that is terrified of birth and death, do these women not need an incredible amount of support to have birth experiences they can look back on with a sense of power? I do not believe my trying to help a lady have a decent birth in spite of the hospital environment will make women go, "Oh, okay, it's all good, then," and lessen the minuscule percentages of those who choose home birth. I alone am not going to get those 98% to change their minds, regardless of all the stats which tend to support the idea that home birth is as safe or in many cases even safer than hospital birth. Many people may understand that their fears are overblown on an intellectual level. But the collective fear is so big, people still pack their bags and birth in the hospital with obstetricians anyway. And if that's where they feel safe, and that's where they want to be, that's where you'll find me. I'm not there to judge what makes someone feel safe. I'm just there to help when I can. And believe me, when things go awry, I'm very grateful for obstetricians and technology. I am not against hospital births or doctors or nurses at all. What I am challenged by are many of the policies and protocols which detract from the normalcy of most births. This is where change must happen, and I'm hoping it will grow from more positive hospital birth outcomes, which the presence of a doula is shown to increase.

Isn't every birth a woman looks upon with love and good memories a triumph, even if it isn't filled with the potential for "perfection" (meaning perfectly undisturbed, perfect environment, perfect bonding, etc.)? Isn't it good to have a few more women come out of the hospital feeling like strong and powerful mothers? Of course it happens that sometimes when a woman looks at her birth with fondness I am knotted up inside at the things she maybe didn't know looked heinous to me. But who am I to tear apart her birth experience because my vision of great birth isn't the same as hers? I WANT her happiness, and am thrilled for her triumph, and I have learned not to be attached to my version of "perfection" in birth. If something was really awful and she was unconscious of it at the time because she was all hopped up on her love and ecstasy hormones, adoring the nurse who was maybe actually quite impatient with her, and feeling bonded with the doctor who brought up emergency cases with the resident in front her of while she birthed, it will come up. It will sit in the back of her memory until it is ready to burble up to the surface for illumination. And when it does, I usually get a call, and then we process it. Often there are delayed reactions. If it never happens, fine...it is not for me to say what "should" traumatize someone.. but if it does, many of these women go on to choose different routes for their next birth experiences. There are many roads to empowerment.

My path as a doula has morphed from just wanting to see nice births to really trying to help improve maternity care in hospitals. Midwives are doing a great job tending to those families who feel happy birthing outside of the hospital, and God love 'em. There is a big movement right now that is shedding light on the some of the potential pitfalls of hospital birth and illuminating the beauty of homebirth and potential for the amazing strength women possess. Women are taking their experiences and using them for others to learn and gain courage from. One of my favourite examples is the scene in the The Business of Being Born where Ricki Lake gives birth in her bathtub. She is naked, hurting, and vulnerable, yet at the same time in her fullest power. She allows us to witness her bringing her child joyfully into the world, a generous and precious gift to our lost birth culture, an invitation to those who have maybe never thought about birth beyond how soon they can get an epidural, or had perhaps not even had an idea that homebirth was an option they could pursue for themselves. This is potent medicine.

We have had grassroots homebirth movements for some time, but to now reach out to the mainstream, to not just preach to the converted but to begin little by little to shift the collective consciousness from overwhelming fear and contempt of anything that questions what Medicine tells us to, to "I'm still afraid but somewhat curious...maybe some change is needed" is crucial. While the rising Cesarean rate and crazy induction and routine epidural epidemic continue to wreak havoc in North American hospital birth, this slight shift gives us a glimmer of hope that we have to nurture and help grow...hope that our birth wounds can begin to heal...slowly, little by little, decade by decade. Along with the work people do to raise awareness, consumers of medical care must also become aware of their responsibility in birth. As long as we put all the power in a doctor's hands to get our babies out, the pressure on them is enormous, and their fear of not doing everything possible to meet these expectations and maybe even the fear of litigation makes medical maternity care often very aggressive indeed. We cannot simply lay blame on Medicine...we have to look at areas where we may have abdicated our own responsibilities as well.

Doulas, with their belief that birth is usually normal and healthy, go into the hospital with a couple and try to keep them, within that environment of "what if" and "risk" and "danger", connected to their intuitive knowledge, their practical wisdom: their motherwit. I choose to do this as my part. This is my small contribution to what I hope is healing. One mother, father, and baby at a time.

The doula training I provide reflects this impetus to create healing within the system that often perpetrates great wounds (while honouring the many blessings it can also provide). Many doulas have contacted me over the years, feeling woefully unprepared for doing this crazy job within an environment that can be resistant and sometimes cruel. While I feel that my work as a doula has changed its shape over the years, I feel that training needs have changed too. I think we need a paradigm shift in what a good doula training constitutes. I do not believe a woman can take a 2 or 3 day training and do this job with enough skill and enough tools with which to protect herself emotionally. This approach doesn't gel well with this profession. This is why I believe wholeheartedly in the apprenticeship model of learning, and strive to promote it as a new standard of doula training. While many trainings are excellent given the time they're done in in terms of learning hands on labour support techniques and how to deal with challenges, a lot of the students are very focused on papers and credentials and sometimes arbitrary limitations that are as fear based as hospitals are, and I have not found those things to confer good doula skills. Yes, it is up to the doula to continue her education and be self motivated to study, but this kind of learning does not necessarily help develop wisdom.

I believe strongly in the value of having an experienced birth attendant doula the doula (yes, I am using "doula" as a verb) as she embarks upon this journey of birth healing, helping her build her skills, recognizing her vulnerabilities, being involved in her education and development. I like to bring her into the hospital with me so she can observe, without pressure, as birth unfolds, no matter how it is. It is good for my students to have to shift gears and prepare for the planned C-section they were hoping our client could avoid and bounce creative ideas of how to give the best support off someone experienced. It is good for them to call me in a shaky voice telling me they're not doing well emotionally because the birth they are at is really hard, the woman is losing it, barfing uncontrollably, and the novice doesn't know what to do to make her feel better, learning the lesson that sometimes you can't and you just have to keep trying and be present. It is good to get a call in the wee hours from a new doula who has witnessed something traumatic saying, "I am so angry and I don't know how to go back in there and do a good job" and have someone who has been through it talk her off the ledge and bring her back to her centre. It is good for them to miss a birth because it was so fast near the end and know clients were so happy because it went well and are grateful to her because they used all that good prenatal guidance they were given, and good to be able to call and ask, "they're not just trying to make me feel better, right?" It is good to have gatherings so the apprentices can build community with each other as well, and can vent and cry, laugh and muse, ask questions and come up with their own answers with encouragement. And it is good for me to learn from them too.

As I continue to support women in birth, and hopefully will continue to do for decades to come, I continually develop my approach to training new doulas. This is important work. We are striving to shift the pendulum, adding our voices and skills to those who are also working hard to illuminate, educate, and empower people about what birth has the potential to be. I am excited that my birth and postpartum doula trainings, as well as MotherWit doula mentor training workshop is sparking interest in student and experienced doulas around the globe who are realizing the potential they have to be a wealth of resource and support for parents to be and new doulas. Though I don't know if I'll see radical changes for the better in hospital maternity care in my life time (though being asked to give doula workshops to nurses and even medical residents has been a really pleasant surprise), I will remain steadfastly hopeful that doulas are making a difference not just to the individual families they serve, but to our culture as a whole.

This is my path, and I'm sticking to it.