MotherWit Doula Training Toronto

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

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

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

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

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

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

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

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

https://www.facebook.com/event.php?eid=113164405449886

http://www.motherwit.ca/Doula-Training.htm

I'm looking forward to hearing from you!

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

De-Granola-izing the Doula Image

When the average person thinks of a doula, images of earthy crunchy new-agey women with braids come to mind. We are teased in the media and in medical circles, our nurturing, supportive, natural earthy birthy vibe creating depictions of us lighting lavender scented candles and incense, chanting Goddess songs, eschewing all things "intervention".

I like to laugh at myself. There is obviously truth in humour. It is TRUE we do things like "hold space", spritz essential oil laden waters to liven up the energy in the birthing room, "point our toes" towards the place a doula sister may be attending a birth to add our positive vibes to the experience, and get really excited about babies coming out naturally. You're not going to see a doula running around the birthing room in an power suit and heels. You're more likely to see us with wet spots on our t-shirts indicating we have a nursling somewhere, a comfy flowy skirt (who can squat in dress pants?), and perhaps a chunky sweater to keep us warm in the hospital. So sue us. I do assure everyone that I don't eat granola, I don't dig tofu, and I want to smack people who break out into spontaneous sisters-in-the-light-of-Goddess songs during quiet, profound moments in groups. In situations like this you will usually see my MotherWit team and I giving each other sidelong eye rolls and subtle finger-down-throat gestures. As a crew, while we do the normal flaky stuff, we shy from the embarrassing. Our image is already hippie dippie enough without having to add fuel to the fire (around which everyone's arms are linked and are singing Kumbaya).

Given we are already teased to the hilt about our image, I think it's a good idea to keep the rest of our secret flakiness to ourselves. I have seen many doula businesses advertised with names that will never get a doula taken remotely seriously by any average mainstream client (who needs doula support as much as one of the "converted") and will alienate mainstream medical/midwifery professionals. You may not care about this now, preferring to maintain your own personal integrity about your beliefs, and so be it. But if you really want to work at your trade, it will be an important future consideration.

I'm not going to pick out any real names I've seen, but there have been some doula service titles that have made me cringe. I mean, I'm a "do what you will" kind of gal and far be it for me to criticize, but because I sometimes do talks with medical people and hold open houses for strangers to get to know my team and what we do, I'm hyper aware of not coming off as uber flaky so as to fulfill my intent, which is to serve whomever wants doula care. Preaching to the converted who may flock to the wafting lavender mist is easy. I prefer challenges.

So names that sound something like "Gypsy Moon Goddess Red Tent Doulas" or "Sacred Star Dust Doula Care" just don't fly, in my part of town anyway. What else? Join me in the fun! "Little Angel Spirits Manifesting Doula Care"? How about "Blessed Womb Fruit"? "Patchouli Breath and Unicorn Farts" or "Vaginal Way Doula Collective" really sum us right up!

I think we should have some bad ass names just to balance out the granola image. How about "Jesus Built My Hotrod Doula Services"? I like "All Liquored up Roadside Doula Services....and Waffles!" Ah, we could get so creative!

In any case, revel in your granola-tude ladies, but be aware that as an important and growing presence in maternity care, our image is definitely something to consider. Find balance and be accessible...but don't sell out!

Peace, Babies!

How Medical Professionals Can Improve Birth Experiences

While we have many benefits to our maternity care system, even medical practitioners will tell you that there are also many flaws.

As a doula, while I work within this system helping women have the best births they can, I am not of it. It is my job to do my best for my clients, using the more grassroots skills of birth supporting to facilitate their normal labours, while respecting the parameters of the hospital protocols and policies. As most who have birthed within this system know, the hospital routines do much to disrupt the flow of normal birth, making the job of the mother (and doula), extremely difficult at times.

I believe in being realistic. Obviously, we cannot at this moment in time recreate the environment of Ina May's Farm, with its amazing birth stories and outcomes. As a doula I cannot make the system suspend their routines. Even if the doctors and nurses wanted to, they themselves are bound to work within the rules of the environment. So for now, it is what it is. I believe in improving what exists right now before projecting into my future vision of the perfect hospital birthing centre. It is by grounding ourselves fully in the now and keeping our feet planted on the earth that we can reach for the sky. My mandate is to work with what exists in our immediate situation.

Right now, even within the limits, there are ways to improve maternity care, contributing to the safety and enjoyment of a family's birthing experience. It is my hope that by witnessing the evidence resulting from these changes, the new generation of medical maternity professionals will begin to create change to the infrastructure of the hospital system in conjunction with the powers that be that make a hospital run. Big dreams, huh? But why not? I believe in ripple effects and morphic resonance. I believe that our birthing functions are highly influenced by our culture. Culture is something that can be created. These are my humble suggestions of what medical professionals can do to contribute to the healing of the hospital birthing culture and improve birth outcomes.

1) Understand Normal Birth

Normal doesn't refer to how about 98% of babies born to first time mothers come out, which is with the mother epidural-ed and on Syntocinon (Pit for you Americans). This type of birth is marked down on records as "normal vaginal delivery", but it is not. It may be considered normal because that's what usually occurs, but given how the body works and the dance of amazing hormones and mechanics that must align to get a baby born naturally, this scenario is anything but normal. In order to change hospital birth culture, we must get back to the original definition of normal birth. "Natural" birth does NOT mean "vaginal" birth. A natural birth is one that is for the most part ummedicated. I won't get into variances much here, but personally, I believe if a woman receives some Synto at some point in labour, as the environment impedes her own natural flow of oxytocin, and she births with no epidural, that goes down as a natural birth in my book. Purists would argue, but remember, I'm talking hospital birth.

I feel that student doctors and nurses should shadow a midwife or doula, someone who's cultural view of what normal birth entails is different from theirs, in order to witness how labour really works.

Though obstetricians are absolute experts in dealing with our birth emergencies (and God love 'em for it), the vast majority of them have never hung out with a woman from near the beginning of her labour to its end. They have not sat with her prenatally, discussing some of the factors in her life she brings to her birth experience, understanding her fears, concerns, and hopes and listened to her at length. They are not aware of some of the emotional issues she has that could potentially impact her labour. They know labour from walking into a hospital room, asking questions, reading monitors, checking dilation and fetal position, and "delivering her" when the time comes. They don't come to her home afterwards and hear what she has to say about it, how she feels, how the experience changed her life (for better or for worse). Medically, labour is something that exists within a given set of guidelines, and when birth doesn't fall into those guidelines, a woman is treated with drugs or instruments. Rarely have I seen an obstetrician turn to the very simple things that midwives and doulas know could effectively put a birth back on track. To really be an expert in something, I believe witnessing what its true normal is is crucial to our greater understanding of it. Facilitating a new doctor's witnessing of a normal birth or two without the distractions of being the clinically responsible one in the room is something we CAN implement now. Yes, I know the students and residents are really busy and that they are needed for emergencies. But I have this sneaking suspicion that if they could truly see what birth is in its essence as opposed to its symptoms and pathologies, we may see some radical changes to the hospital birthing culture, leading hopefully to less emergencies.

2) Acknowledge How Sensitive Birth is to the Environment in Which it's Contained.
Most doctors acknowledge that stress plays a huge part in the etiology of many of the prevalent ailments we have in the modern world today. They prescribe reducing stress, some even recommending the benefits of yoga and meditation. They know that exercise releases endorphins and contributes to mental health and well being. Blood pressure often goes down when stress factors are reduced. These are common sense givens.

It is widely accepted that tension can contribute to our digestive dysfunctions, resulting in constipation, diarrhea, ulcers, etc. Stress contributes to sexual dysfunction too, leaving folks with little desire or ability to "perform".

Birth is a physiological function that is both about elimination and sexuality, both functions highly affected by a person's emotional state. Something has to come out, and the woman needs to get into a certain state for it happen normally, surrendering to wavy sensations that make her dreamy and uninhibited enough to move a baby through her vagina without a memory of trauma anchored into her experience.

The hospital environment is inherently stressful. Visible machinery is around to remind a woman that complications may happen. It smells like antiseptic, which is associated with illness. Studies have been done which suggest that changing the smell reduces the rate of intervention. Women are constantly told that they have to be monitored and measured to ensure everything is okay. It is well known in midwifery and doula circles that a dark, quiet, comfortable, private space is one most birthing women respond to well. Birth tends to happen more normally, meaning her oxytocin and endorphins work optimally and she can move around as she pleases to facilitate the mechanical process, when a mother is disturbed as little as possible.

Of course, we cannot ask doctors and nurses to not do what they need to do to monitor a mother and baby the way their hospital dictates, but there can definitely be improvements within the given parameters. There are simple ways to protect the environment for a mother to contribute to her nice hormonal flow, even when there are protocols to be followed. For instance, knocking gently at the door and closing it softly would be a huge improvement over barging in and leaving it open, exposing a woman to all the distracting hospital noises in the hall. Instead of flipping the light on to read machine outputs, carrying a pocket flashlight is an incredibly sensitive way of keeping the environment dark and undistracting. Obviously, nobody is suggesting this if there is a real concern, but for routine checks, why not? Not engaging in idle chatter is also a kind way to leave a mother and her partner the focus they need to get that baby out normally. Doctors and nurses are often very friendly and really enjoy getting to know their patients and making conversation, but interestingly, I find the ones who create a lot of idle chatter and bustle, or who explain every single thing along the way, like "Okay, now I'm going to change your chux pad to keep everything clean...we don't want you to end up with an infection. I just had a patient the other day who had such a bad infection...." have patients who end up needing more interventions.

If you're in the bathroom trying to poop after it's been a couple of days, the last thing you'd want or need is a friendly chatty person on the other side of the door, or worse, opening the door and looking at you, talking to you about the weather. If you were trying to get it on with your partner, having someone barge in with the door hitting the wall as an extra oomph to indicate their efficiency, leaving it open for people in the hallway to look in while strolling by, saying, "Don't mind me, I'm just going to restock a few things...may as well as it's not a busy night tonight," you just mind find your mojo fizzle a bit.



Conversely, making no contact with your patient isn't good either. A nice sit down little visit in which you ask a woman what you can do for her is an amazing morale boost she will appreciate. When someone takes time to check in gently then leave the couple to it, they always say, "Wow, that person is really nice!" Feeling like someone cares about what they may want builds trust, so that if you need to intervene in some way, they know you have their best interest at heart. Doing vaginal exams while on your hospital phone or not introducing yourself before doing some kind of assessment is NOT going to get you in the good books. So if we go back to the poop scenario (and I apologize for that), if someone is having trouble in the bathroom, having someone outside the door who's taken a little time to get to know them saying, "if you need anything, I'm here, but I'm going away now to leave you to it" can be much more security building than feeling like they'd have to call on a total stranger for help.



As a medical practitioner, you must honour that labour is sensitive to these distractions. It's not women being demanding divas...it's the fact that like pooping and making love, the process is easily disturbed. Except that once labour is disturbed, the ensuing problems get treated and the birth itself is blamed for having gone abnormally. No fair. This leaves women feeling like they didn't work. So yes, do the job you need to do, but do it with consciousness towards the environment. Saying you have no time is not a good excuse, because in the end, normal birth is a lot less work for you to deal with than having to set up an IV, do a catheter because of an epidural, worry about having to do forceps, etc. And don't worry...if a true concern is bothering you, rarely is anyone going to mind you turning on a light or having a discussion at that point. That is, after all, your job, and the reason most people choose to have their babies in a hospital...to have the benefit of your skills and expertise. Nobody believes that a good environment alone guarantees a great birth...but you'd be surprised at how simple adjustments to it can put a labour that seems stalled onto a better track and how respect for it can prevent some problems all together.

3) Watch Your Words!

There are some things medical practitioners say that are most likely meant to be funny or inspiring, but often just create doubt and fear in a mother. And what do doubt and fear do? Dampen the hormonal flow. It's very simple. Keeping those hormones flowing happily and easily contributes to better birth outcomes much of the time. You want to PREVENT having to use the tools available, not unwittingly contribute to their necessity once the birth vibe has been disturbed to the point of no return.

Harsh, critical words are rarely appropriate in birth. Okay, if there is a true need, sometimes saying, "Okay, Honey, now it's time to give a REALLY big push!!!" is helpful. But for the most part, sensitive labouring ladies can interpret common comments as criticisms. Again with the sex, but we ladies know there's nothing like the buzz kill of someone saying something like, "oh, Baby, you are so sexy...I totally want you. Oh, look, your boobs are saggy!" It's hard to proceed after that. Or, again with the poop, but what if you had a room full of people staring at your naked butt, you with your knees up to your ears, while they shouted at you to PUSH, and then they told you you weren't doing it correctly, that you weren't pushing WELL. I wonder how much longer it might take than normal for that defecation to finally happen?

Here are some of the phrases that need to be kept to oneself while making a clinical assessment that is perhaps for you a red flag, but has not shown itself yet to be causing a real problem in labour:

"Wow, that's not a small baby, is it?" Women are understandably terrified of birthing a huge baby. The fact that something on average of 7 pounds or so has to come out their vaginae is a concern enough for most. Adding fuel to that fire by that comment will, in Ina May speak, clench up the sphincters. We want those sphincters to OPEN, not shrivel in fear. These words will prevent opening in many women. Poking about inside a woman's pelvis with a doubtful look upon your face, saying, "hmmm, it's not so roomy in there, is it?" is also not so helpful.

I know doulas who have been told by medical practitioners, upon having been taken aside to give them a heads up that their patient has been sexually abused as a child and that certain phrases most people can handle are terribly triggering to a woman who is about to give birth, such as, "open your legs, I'm going to put my finger inside you," or, "you're so tense...if you just relax this won't hurt you so much.", that all that is just hocus pocus. I have had clients told, "If you're bothered that much by my finger, how on earth do you plan on getting a baby out of there?" I heard once in response to someones simple request to be upright in labour, "This is obstetrics. You don't always get what you want. When it goes well, you're lucky." Well, the last time I checked, birthing women aren't practicing obstetrics, they're trying to have their babies. That statement implies, "I'm the one in charge here, not you. You can have all the good intentions you want, but it will probably be dangerous, and I'm the one who is here to save you, so do what I say." How much do you want to bet that created a self-fulfilling prophesy?

Language is incredibly powerful. A doula's magic is often about creating "word medicine" to counteract well meaning but insensitive comments..like the "Gate Theory of Pain Mechanisms," but in emotional terms. Nobody is asking a medical practitioner not to be honest with their patients about their situation, but paying attention to the wording is crucial. I recently saw an amazing example of how a challenging situation was given much hope by a sensitive resident. A client of mine had been labouring for an incredibly long time with very little progress. She was becoming exhausted and frightened that labour would never progress. Being in the hospital, she was now in a situation where medical suggestions were going to be given. The resident said, "you're doing great! You're doing everything you can and coping really well. It's true there hasn't been a lot of change in your cervix for 24 hours, and there is a potential for concern. But in obstetrics, we don't even consider you having a problematic labour until you're having strong contractions at least every three minutes lasting for a good minute. You haven't even gotten there yet, so here are the things we suggest to get you to that point before we even think about diagnosing a problem...." Worded this way, the woman had hope that there was still a lot of room to try some different medical things to get labour moving. Her struggle was honoured, she was praised, and was told not to worry, that there were still options before anyone started announcing the dreaded C-section. This powerful choice of words I feel contributed to those medical tools working well for her and her coming away with a really positive feeling about her birth. It could have been said like this, "You have been here for 24 hours with hardly any change to your cervix. We're looking at a risk of dystocic labour which can lead to (insert horrors here). Clearly you need help as your body isn't doing it on your own, and if you don't choose these things right now you are endangering your baby." Sadly, I see that wording more often that not.

4) Trust the Woman

The body that has forged this baby and that is working hard to get it out probably has valuable insight into what's going on inside her. Even if she happens to be incorrect, it is still worth investigating for her, making her feel respected and heard. A student of mine went into labour at 34 weeks. Because she was very quiet, a nurse kept telling her she wasn't in labour and that she should just go home. The monitor wasn't picking up contractions, so she wasn't believed. The nurse left the room and the baby was born unassisted. I as a doula have actually caught a couple of babies in the hospital because nobody believed the grunting first time mother standing by the bed could be fully dilated when she was just 4 cm 20 minutes before.

It saddens me that many women get eyeballs rolled at them (behind their backs) and get treated like bothers as opposed to the honourable life givers they are in that moment. After a long birth I have had nurses come up to me and say, "how did you deal with her? She was SO demanding!" when I never really interpreted her as anything more than that natural birthing woman she was. Birth is hard. It's even harder having a natural birth in a hospital environment. Many women need to be touched and encouraged a lot. I just find that normal, not demanding. I do that because I love to. When medical staff interpret natural birth as cumbersome, we are lost. I trust women know what they need intuitively much of the time to get the job done. If she wants to stand on a chair because the floor feels cold on her feet, fine. If she wants to sing or howl or moan, great. If she wants to cry a lot to release pain and tension as her cervix blossoms, beautiful. If she wants me to press into the small of her back for eight hours, great! This is my trusting her. Sure, there are times suggestions are warranted because she's caught in the "rock and hard place" space, but even then I think the baby will most likely come out given enough space and time.

When women are forced into a certain position and told how to push, this shows a lack of trust. They are told, "You're baby WON'T come out if you don't push HARD!" They're told if they don't have the episiotomy they will end up torn from stem to stern (which strangely enough, I have almost never seen happen when a woman refuses a non emergency episiotomy...in fact, often they don't tear at all). It is assumed they will lose all control and just squat in a corner and birth there if there aren't some ground rules (really, would that be so bad?). Sometimes it is even assumed that because a woman claims to want a natural birth, she is stating that this is her intention at all costs. This is a very damaging assumption. There is not trust in it at all.

Obstetrics focuses so hard on the pathologies than can potentially occur in the birthing process (and that has many benefits, obviously), that a lack of trust in the normalcy of it develops. There is a terrible lack of trust that everything will be okay if the woman just does what she wants in labour. Really, though, if all hospitals were equipped with Dr. Michel Odent's "salle sauvage" with a comfy platform of cushions, a birthing pool, perhaps a rope to hang on, and the constant presence of a patient woman (a doula or midwife), intermittent auscultation, almost no vaginal exams, and freedom to do what she wants to cope, how much LESS would we actually need obstetricians? If a woman received more trust in her birthing process, I do feel the rate of needed interventions in birth would go down. Isn't that what we ultimately want? It should be. If an obstetrician loves natural birth and wants to be involved in it and not just the complcated cases, that's awesome! Then they are probably part midwife at heart. Maintaining quiet clinical vigilance while having good faith in the woman's body lends well to maintaining the physical and emotional environment women need to give birth within as normally as possible...and hey, if shit happens, they have all the skills and tools available to do what they need to do.

5) Remember that Birth is Sacred

Okay, pour granola over that and add a drop of patchouli if you want. Have your giggle. But it's true. This is the birth of a child, a human being's very beginning. It is the most monumental event in a family's life. Their experience shapes how they parent, how they feel about themselves as birth givers. It affects their lives. It is for a reason that a woman's state is usually one of ecstatic trance when she delivers her child happily and normally. It is so she can fall madly in love with her baby. Be part of that love fest. It's good for your health.

Connect with your patient in a way that will make them remember you fondly. Every day you step into the case room, you have the opportunity to create a positive experience. It doesn't take much more effort than you would normally have to expend. Make eye contact. Smile and say hello. Ask her what she needs. Don't be afraid to offer touch that's not clinical if this feels appropriate. Kind, loving, encouraging words from a medical person are particularly powerful. You will be remembered for the rest of that family's life, as this is a sacred day. If there is one thing I ask you to remember, it is that.

At the end of the day, what interventions a woman may have had during birth will probably not have as much impact on her as how she was treated and how she feels about her overall experience.

I leave you with a personal story to show you what I mean. I'm an old natural birth promotor. I am not into most hospital protocols. I like the squat in the corner approach. When I was pregnant with my first chid I walked into the hospital I planned to give birth in to check it out, walked out and knew I simply couldn't do it there. I felt profoundly unsafe. I knew home birth was my best option. So imagine me during my second labour, after having had a beautiful, empowering, amazing home birth to my daughter, ending up having to transfer from midwifery care to a hospital to receive medical care. I cried a lot standing in the parking lot of the midwives' birth house waiting to get my non progressing butt to the dreaded hospital. I was scared. And lo and behold, I had actually had a really nice experience. I am one of those really lucky ones, yet it would be so easy for everyone's experience to be similar to mine.

I was only there a few hours before my son was born naturally (all be it facing upwards), but in those few hours I encountered a couple of doctors who made the experience good for me. Of course, I arrived at the hospital at shift change. I saw a doctor I recognized from having attended births several times at that hospital. I started sobbing saying I was having a hard time. Instead of freaking out and worrying about ending my suffering and getting on my case that I should have been in a hospital in the first place, she diffused my drama in a wise, motherly way, put her arms around me and actually slow danced me through a contraction! I cannot say how good that felt to be vocalizing into her secure, substantial bosom! She broke my waters for me, which actually did the trick, and I remember her saying, "There, Mamaleh, you were around 4, not you're 7."

She left soon after, and I was so nervous someone not as understanding would come on shift, but I was blessed yet again by a lovely older male doctor. I only remember snippets, but his positive, gentle presence meant so much to me, and I remember it almost 17 years later. I was yelling like a banshee, yelling for an epidural, but refusing one at the same time. Sure, perhaps there was some serious eyeball rolling out at the nurse's station, but the doctor never projected any annoyance of me at all. I was a mess, screaming between contractions with back pain. He wasn't afraid of me in my rawest state. When he needed to communicate something to me, instead of roughly trying to get my attention or telling me i wasn't helping myself all out of control like that, he stood near me quietly and calmly. When the pain took a small break, I'd look at him and say, "I'm so sorry, I'm so sorry, I don't mean to be screaming in your face." He would touch my arm, look me in the eye and say, "it's your second baby, you're nine centimetres, you're almost there. It's hard." He would tell me not to apologize, that he knew it hurt. When my baby finally came out posteriorly, the resident, also very kind, didn't need to hand him to me as I grabbed him by his shoulders and took him myself. I looked at both these respectful, gentle men and told them, "Thank you." They told me I was a champion. Not that I need my ego stoked, but for some reason those simple words validated everything I had gone through to birth that baby naturally (which I don't regret one bit) and the fact that they took a second of their lives to honour my experience remains with me. Frankly, I don't at all remember the several vaginal exams I received. I don't remember being tethered to the machine for the few minutes I pushed. I don't really worry about the fact that my baby needed to be examined because of grunty breathing and was taken away from me for a minute, and I don't remember much of a managed third stage and an iv inserted because I was bleeding.. and remember, I am one of the "routines disturb birth" preachers! All those things I planned to avoid and worried a lot about prenatally when I envisioned my unexpected hospital birth experience pale in comparisson to the very positive emotional feedback I received from the doctors who tended to me. That's oxytocin for you...it makes you trusting. When you reach out and find someone kind on the other side of your pain, the effects are amplified by the presense of that lovey dovey hormone. I wished I could have had my baby at home, but I have no complaints about my hospital birth.

I hope this story illustrates how easy it is to honour a woman's birth experience and how easy it can be to infuse her experience with something positive she will take away with her and remember almost 2 decades later..and probably will forever. It's no matter that the doctors likely don't remember me at all. It means a lot to me that the first hands that touched my son were kind and gentle ones. I feel he probably had a very nice imprint in those first few moment of his life...patient hands and a mother who was made to feel like a champion. Not a bad way to come into the world. You hold the power to create a happy beginning like this too. Whenever you feel impatient or harried, take a second before you walk into a birthing room to take a breath, and focus on the now. This woman in front of you is bringing forth a new life. This is sacred. Please, please don't forget that.

Considering Doula Training? Come Join me in Nova Scotia!

There are times you come home from a birth and are filled with the feeling, "I understand many of the things I saw happen in the hospital were done by good people, performed with well educated as well as loving intention in the hopes of sparing a labouring mother and baby from unwanted birth complications.... yet despite that, I cannot help but feel I have witnessed something brutal." What do you DO with these feelings?

Sometimes you can come home with all of the beauty and struggle you've witnessed and feel like there's no way to ground it all, and to process everything you've seen and learned. How do you build a community to gain strength from?

Birth is an amazing thing, and you may feel like you want to participate in the process, helping a couple feel emotionally safe and supported while they work hard to bring their baby into the world. How do you go about doing so?

Perhaps you've always wanted to be involved in childbirth, but didn't feel like you wanted the clinical responsibility that being a doctor or midwife entails. Where do you go to learn how to provide empowerment and comfort to women birthing in all kinds of different settings?

You may see the childbearing year as an opportunity in a woman's life for immense healing and personal growth, and wonder how you can learn to nourish her health and build up her resources to birth the way she wants. How do you learn how to move beyond "timing contractions" and applying techniques, to truly embracing the whole woman and guiding her to finding her strength to give birth happily, whatever that means to her?

Are you interested in not just witnessing and helping with birth and mothering, but in participating in creating healing for our challenging birth culture one mother, father, and baby at a time?

Are you interested in getting off the divide between "us" and "them" when it comes to a holistic vs. medical approach to childbirth and learn to build bridges to create healing on a global level, serving what women want and where they are at right now?

Would you like to learn how to be a doula in a beautiful environment, learning not only about the art of doula care but discovering more about yourself, your strengths and your fears, and finding opportunities for your own personal growth and healing?

Would you like to learn how to be a doula in a supportive community, receiving feedback and followup as you transition into your important role?

Would you like to feel that mothering and learning are not mutually exclusive, and feel that your nursing child is welcome within a circle of women learning the same things?

Would you like your learning process to be a powerful, nurturing, transformative experience for you?

Do you want to immerse yourself in the learning of all things birth-y over a period of six days and evenings in a workshop that goes beyond what you ever thought you knew about being a doula?

Would you like to let go of the pettiness of politics and mandatory qualifications and fear based impositions to flourish as the doula YOU are meant to be, embracing your work as the grassroots but deeply socially responsible role it is?

Would you like to learn the art of doula care from someone who has been doing this work for nearly two decades?

Did you know that a doula is not a liscensed professional, and that papers and organizations are not necessary to bring your very best work to a birth? Certifying papers show you have met the requirements of any given body who provides doula training and an outline of agreed upon doula behaviour. While this is a great way to feel you've accomplished what you set out to do and a good way to know you are on the right track by being evaluated by an experienced person/organization, you are technically allowed to do doula work anytime in your life, with or without papers. Would you like to feel confident about your abilities to provide excellent doula care even if you are called on to be at a birth before being or without being certified?

Then come and join me! I am giving a training in beautiful New Germany, Nova Scotia, at Windhorse Farm www.windhorsefarm.org from July 24th to July 29th.

The deadline for applications is June 18th. No applications will be taken beyond this point. For more information, go to: http://www.motherwit.ca/MotherWit.ca_Birth-Doula-Training-Intensive.pdf

I would love to see you there! Send me and email and we can chat about it if you have questions. Payment plans are an option. info@motherwit.ca

This course is neither the beginning nor your end of your journey. Never at any point will you learn all the tricks to being a doula and then you're done. It is a life long process. It is my hope this training will serve as the garden where you will push down your roots deeply and find nourishment, so that one day your branches reach far into the sky as you contribute in your own loving, unique way to the path of healing.

How to Prepare for Birth

The sensations of labour vary for every woman. Not only from woman to woman, but from labour to labour. I have had births that felt virtually painless for most of the labour, to having sensations that kicked my ass leaving me breathless and begging for mercy.

I honour whatever approach people take for their births. We all have different personalities and make-ups, and everyone has a different relationship to strong sensation. For me, while labour pain can be extreme, I can handle it. Unless there were a really good reason to do so, my choice is to not take epidurals or other forms of pain relief to manage the sensations. It hurts a lot, yeah, but having been through it, the endorphin and oxytocin reward at the end of the journey is so worth it. It is the most intense high I have ever had. I can draw the memory of that high into my being far more easily than I can the body memory of the pain. But the sensation of nausea? Youch. If I had the kind of nauseated labour I see some women have, or if labour felt anything like my first trimesters, I would seriously question whether or not I would want to have natural births. The sensation of nausea is so odious to me, that given the choice between a 36 hour posterior labour and a 12 hour stomach flu, I would absolutely, without any misgiving, choose the 36 hour labour. Because of my intensely difficult relationship with the sensation of nausea, I have compassion for women who have a feeling the sensation of labour might be something they absolutely abhor. Some people can handle achy pain but not sharp pain, or some breeze through a terrible bout of food poisoning cramps, while a migraine may traumatize them. It is such a subjective thing that it is important not to pile women all into one group, give them one method to prepare for labour, then send them off promising if they do it correctly they'll "be just fine". One may argue, "But labour pain is normal and natural, something good is happening in our bodies, therefore it can be done...it's not like the stomach flu or migraine, which are pathologies and trigger a stress response, thus exacerbating pain." True. But nausea and vomiting in labour are totally normal and natural as the body makes room and purges what it doesn't need..it doesn't mean I'd like it or be okay with it. Despite its normalness, it would trigger great anxiety in me. Luckily, I don't have pukey labours.

The challenge with birthing is that, if you've never done it before, you're not aware of how intense it's going to feel or how you're going to cope....whether the sensation is one of those types that's "safe" for you or challenging on a deeper level. This creates anxiety in women. When I work prenatally with my ladies and they invariably tell me they are nervous about their upcoming births, I say, "Great!" This is an opportunity to explore where she's coming from. I reassure the lady in front of me that it is perfectly appropriate to be anxious when teetering upon the precipice of the complete unknown. Using that energy usefully aids women in gathering to them what they need: resources, both external (support, primary care, knowledge of ways to help them cope) and internal (emotional exploration, cultivating an ability to relax and breathe deeply, maintaining presence with challenging sensations or emotions). A doula's job is to help a woman build up her resources.

Part of my prenatal care is to ask a woman what kind of approach she'd like to take with her birth. This helps me to figure out whether or not she's interested in having a natural birth. Contrary to popular belief, it is not only the flowery skirted ladies with a stockpile of incense to last through the Age of Aquarius, or whatever age we happen to be in, who hire doulas. In fact, those who procure the services of doulas in my neck of the woods are usually urban professionals in their mid to late thirties who are highly educated and well read about the birth process, with a lot of concrete ideas as to how they'd like to approach their birthing sensations. They've found whom their friends and relatives have told them are the best obstetricians in town. Their belief is that the combination of good obstetric care and the nurturing supportive care of a doula creates the best of both worlds for them. While many of them really do want to "go natural", there are those who are not that interested, and want their doula there to help assuage their fears and hold their hands through the epidural and just be a friendly face to hang out and make them and their partners comfortable. Fair enough. I serve whomever wants me at their birth, and my mandate is for them to feel like rock stars no matter what their approach. But I do have a few guidelines I feel are important for all of them to consider.

1) Prepare for anything and know you're great no matter what. Just about the only thing I can guarantee about birth is that it is unpredictable. I guide my clients into getting their heads around all contingencies. While I absolutely believe that the VAST majority of healthy women with good heads on their shoulders, if well surrounded but undisturbed in a cozy environment they felt safe and supported in, could have their babies with little to no intervention, birth, especially hospital birth, takes some preparation and knowledge. The whole, "Do nothing, have no fear, and you'll just open like a flower" approach is not useful or realistic in an environment that tends to make sphincters shrink rather than blossom. Neither is the, "I'm going to have an epidural the second I have pain, and my doctor will 'get the baby out' at some point and then it will be done" approach. Both extremes have the potential to leave one feeling disappointed at best, to downright traumatized at worst.

Imagine this: What if you are planning to have an epidural as soon as you feel pain and it doesn't work out that way? For instance, what if you have one of those types of labours in which you're having a huge amount of pain at 1cm? Some women just have a lot of pain in early labour. This doesn't mean they're wimpy...we have to get out of the mind set that a number of dilation equals an expected sensation. This isn't true. So what if you're having 2 minute apart contractions that you consider rate an 8 on the pain scale, you're planning an epidural, and lo and behold, nobody wants to give you one because doctors don't really like to give epidurals to people at 1cm (for good reasons)? You would be offered other kinds of medications like narcotics, but anyone who's taken those during labour knows they don't really do the job that well if you're truly hurting.

What if you were planning an epidural, you get to the hospital and the pain starts, you ask for the Epidural Man, and lo and behold, there are 3 Cesareans in a row he must be present for? I have seen women have to wait 4 hours for an epidural. Sometimes they give birth before it comes. It is not the norm, certainly. But it can happen. Or, what if you have the epidural, and you are one of those ladies it doesn't work for, or it's all weird and makes you feel numb everywhere except for a two inch patch of excruciating pain in one little area on one side of your belly? What if you planned and epidural and you give birth too fast to get one? You can begin to see where having skipped the chapters on pain coping techniques in your books or caught up with text messaging during that part of your childbirth education class might not have been the smartest of ideas.

If you are going to plan an epidural, that's fine. But always prepare for natural birth too, because you never know. The last thing you want is to be faced with pain you never expected or prepared for because you decided to give all your power and jurisdiction over your sensations to an external source. Give over all your power, and the potential for birth trauma here is enormous. Do yourself a favour and get some tools to help you cope.

Conversely, what if you're planning a natural birth, you've done all the preparing and totally believe in yourself, that you can do it and everything feels like it's going to be great...but it doesn't end up this way? This is not a bad approach at all, and I believe very much in the power of positive thinking and visualization, trusting that the bodies who made these babies know how, without a lot of instruction, to birth them normally. Childbirth preparation truly comes more from the work we do on the inside than reading a bunch of intellectual information. However, having an understanding of what might happen IF something comes up and you find yourself in a position needing to make some hard choices about things like pain relief or you end up having that Cesarean you NEVER expected would ever happen to you, is important.

I don't think it's a bad thing to at least skim the info on what goes on when things don't go the way you'd hoped. I know this sounds silly, but it bears keeping in mind: reading or talking about a Cesarean will not make it happen. As logical and rational as a culture we are, superstitions linger. One day I was talking to a group of OB residents about birth plans. You know what their number one reason for not liking them was (for this group, anyway)? They believed they "jinxed" labour, that if a woman commits her deepest wishes on paper, it basically evokes the wrath of the evil eye.

Deep down, I think a lot of people believe that if they read the chapter of their favourite birth book on Cesarean and invite that knowledge into their minds, it might "make" it happen, and it is better to be blissfully ignorant. Saying all the magic words and doing everything right goes a long way to co creating a wonderful experience, sure, but again, there are no guarantees. Having a basic understanding of what it might be like to switch plans is a resource, not a hex, and will lend well to the situation if it ever comes up. For example, "I'm lying on the operating table shaking as if I'm having convulsions..oh, phew, that's normal, I remember reading that...it seems hard to breathe, am I dying? No, wait, it's just the muscles that are a little numb, I actually can move air into my lungs...breathe, breathe, breathe, I will be meeting my baby soon." You can see how not having a little knowledge here about the Cesarean process could make this a more terrifying experience than it already is.

So PREPARE! The process of birth IS important to a woman's experience of motherhood, sexuality, feminine empowerment, all of that. This is what I'm all about. AND, it is unpredictable. It is so important, especially if birthing in a hospital, which, frankly, does tend to generate more need for intervention than you would expect, to prepare at least a little. AND, it is important to remember that the gold medal is the BABY, not the birth. All women get this somewhat patronizing message when faced with an intervention they didn't want, but there is truth to it. It is not uttered just to placate you into accepting something you never thought you'd want or need. It is the truth...absorb it, own it, breathe it...that you are amazing no matter what. You are noble and fierce for all the work you have done. This is not to say grief and disappointment are not warranted in a birth that didn't go the way you wanted. There is nothing selfish or unrealistic or stupid at all for having hoped and believed you could move mountains in labour. Normally you can. But sometimes it just doesn't work that way. We are not the only ones on the journey...sometimes the baby has his own ideas. It is vital to healing to emotionally process our births and it is important to recognize and deal with situations in which you felt less than empowered or honoured. But YOU are amazing. Dude, you had a BABY! No matter what, you are a hero

2) Manage your expectations. Preparing for natural birth is all about stretching...stretching your body, stretching your mind, stretching your heart to open to the magnificent love of and for a new being, and stretching your limitations. Expect it to be a challenge. Don't be cocky. Everything about you will open wide. When I get to the part of my prenatal meetings with my ladies where we talk about whether or not they're interested in birthing naturally, I often get the answer from well read, well informed women who are choosing to birth in a hospital, "I would like to do it as naturally as I can...but if it gets to be TOO much, then I'm open to taking an epidural." What this says to me is, "I have a secret wish to have a natural birth and reap all the amazing benefits for me and my baby as well as be like those tranced out women in the film Orgasmic Birth....but because this is unknown territory, I don't want to feel like I wimped out if they have to scrape me up off the floor in a quivering mess of pain induced insanity. I give myself permission to call time out to spare myself from entering into what I fear could be my worst nightmare."

There is also fear of judgement. "What if I share my precious dream of natural birth to the world, then I don't have it and everyone will say, 'ha ha, told you so!'?" We always feel like we need to qualify. Personally, if I stated I was intending to have a natural birth and resisted the temptation to give the pat disclaimer of "if everything goes well", but if it didn't happen and I got judged for it by certain people, well, I'd tell them to go jump in a lake and not associate with them anymore. A woman who's birth reality ends up not matching her expectations doesn't need judgement and messages like, "poor little woman, it was really cute for you to think you could do it...know now you're just like all those other people who yelled for their epidurals when the going got tough"..she needs SUPPORT.

Anyway, back to that "I want a natural birth but am open to an epidural if it gets to be too much" statement. I like to take this opportunity to ask women what "too much" means to them. Because quite honestly, there WILL be points where it is "too much". People rarely have natural births when they have a well padded "escape plan". If I were to say, "oh, sweetie, you'll be just fine. The pain isn't much. In fact, if you breath into point A while chanting phrase B, you shouldn't feel anything at all," I would be a liar and deceiver of the worst kind. Women may say, "why are you telling me it's going to be so hard? Won't that make me nervous and make it so, given that stress makes birth hurt more?" Ah, again with the superstition. I'm not personally so powerful that my words prenatally can make you hurt or not. If I tell you it's going to be hard, two things can happen..it ends up being hard and you are prepared with resources to cope with it, or you've expected it to be so long and hard that it sneaks up on you and we arrive at the hospital to find you're in way more advanced labour than you thought..woohoo (this happens frequently with my clients)! Don't ever think that if I DON'T tell you about the challenge it won't exist. Better to know.

Even those who never knew they were even pregnant and give birth birth after having thought they were just REALLY constipated feel a lot of pain. I don't buy that ignorance of pain is bliss in the case of birthing. But I do like to discuss how the pain can be transformed into power, and that it can be a total thrill ride.

When I ask ladies what "too much" means, they often don't know what to answer. I'm so curious to know what they think is going to happen to them. I ask them, "what are you afraid the sensations of birth are going to DO to you?" I get all kinds of interesting answers. Some say, "I'm afraid the pain is going to make me really mean to my husband or the staff, and they'll get mad at me." Interestingly, media paints the picture of women turning into these impossible hellions during labour, scratching their husbands' eyes out. My experience shows me that in normal birth, oxytocin tends to make women quite loving, trusting, and snuggly. Yeah, they're fierce too, but the ferocity is directed towards managing the energy of their sensations, not emotionally castrating their partners. There can be some irritation, but I rarely see a woman go rabid like Old Yellow. This is reassuring news for those who define themselves by their polite and good behaviour.

Others say, "I'm afraid I will lose control of myself." "What does that mean?" I ask. "What does being out of control look like to you?" What they usually mean is that they will be in such a state that they will lose all semblance of who they are. I tell them that they will change, yes, but they will still be themselves within that pain/endorphin haze, able to take in, process, and communicate what is needed in the moment. Yes, they may lose their modesty in front of strangers, find themselves nude with blood, amniotic fluid and mucus running down their legs, little rivulets of barf drooling from the corners of their mouths from time to time, and that they will be making uncontrollable noises they never thought they'd make. To some, this animalistic image is deeply disconcerting. But really, if you're willing even a little bit to go there, what you will find is freedom and even possibly a level of intimacy you never knew could exist with your partner and those in attendance. There is nothing more liberating than being in that space of pain and mess, looking up in your misery and finding eyes that meet yours in total acceptance of your experience, eyes that mirror back absolute approval and praise for what holy work you are doing, giving you energy, and even having those messes tended to with love and honour. You are safe, and everything is okay. You have "hit bottom" in terms of what our culture deems ladylike behaviour, but having gotten there and found strength in yourself and awe from your attendants, you have found your rawest nature, the one that gets you through to the end of the journey. You have found ultimate surrender in pushing away all cultural expectations of your femininity which believes having it all together is the sign of an accomplished woman; now you learn that where you find your truest power is not in keeping your shit together, but in letting it all go. Sometimes literally. What you have been afraid of all this time is becoming the birthing animal you actually are and have been programmed to be since your DNA decided to light up as "girl". You will come back...I promise. But you will come back having witnessed and activated a deep part of your Self that we are meant to bring to motherhood. You will come back feeling like you've been through a very important rite of passage. And so you have. It is a biological blueprint we fail to honour as a whole, and we must begin to work to reclaim it rather than do dumb things like have women birth in machines while a gaggle of pimply students oggles them with clip boards clutched in their hands, trying to figure out why women can't give birth properly anymore (duh).

We all read the birth books with the secret hope we will make it unscathed and maybe avoid that scary animal place. There is no chant or prayer to spare you from that. It is meant to be. Whether it is painful or not for you, you will go to that growly, trance-y place whether your expression of it is outward or more internalized. You will temporarily lose that intellect we cling so fiercely to and go into an incredibly dreamy place inside you...Labourland. It's the best place to fall in love from.

I dare you to make a commitment to natural birth without a disclaimer. We already know it. You will not have to go around wearing some scarlet letter if you don't reach your goal. Be willing. Be willing to get down and dirty, to open up your THANG, in every sense of the word. If you can't figure out how to "do" a hard contraction, yell your head off if you can't breathe through it. It's okay. What you can always choose to do is use the spaces between. Choose not to waste your in between times negotiating with yourself how much longer you're going to do it for, or how much more you can take. Sink down into what you will find is a deep, beautiful, profound space of rest and quiet. Trust that as the pain cranks up, so will your ability to cope. You will say "I CANNOT do it anymore" only to find three hours later you still are and are just fine. As I mentioned, you stretch in every way...your resources too. Be willing to ride the sensation even when it hurts, be willing to have those huge waves crash down over you, knocking you down. Be willing to get up again tearing at your clothing with your nails, bearing year chest and yelling, MORE! I CAN! Trust that strong contractions are GOOD contractions, and that each one brings you one step closer to meeting your baby...and in between, soften, soften...soften.

I will never candy coat labour pain to a woman. That is not love. That is disempowerment. I just talked to someone who used a method of pain "control" in labour. When I asked her if it worked, she said, "well, I DID feel pain at some points, so I guess we just can't get away from those cultural expectations...the idea of birthing pain is so imbedded in us that we'll always believe it's there even if it's not meant to hurt because it's natural." This broke my heart, because what these methods teach us is that if we do hurt, it's our fault, that the stain and stigma of normal pain must be attributed to the woman's failing the method, not the method failing the woman. I like to see the strong sensations as conducting the hormonal flow. It's a good thing. And perhaps the more we dive in, embrace it, open to it, accept it, work WITH it instead of against it and trust it, the less it may actually "hurt" us.

I remember with my first kid believing with all my heart birth would be the worst pain ever, that I'd probably go crazy, that it would be horrible, but that I just would do it. I'm a paddy ass, so I planned a homebirth to keep myself away from the drugs. I just went with it, saying, "one foot in front of the other, one contraction at a time". And when my midwife came into my room asking me if I felt pushy because I was making some convincing sounds and she found me fully dilated, I said, "What? I did it? Already?" Because even though the sensations were the fiercest, craziest, most mind blowing sensations that made me yell so loudly I thought I was gonna bust, it was never actually bad...if that makes sense. All I'm saying is, if I can do it, wimp that I am who cries when my tummy is upset, you can too.

3) Own your choices. . When it comes to normal labour, I think it's really important for women to own their choices. "I had the epidural because I just couldn't do it anymore" (at 4cm five hours in) is not the truest of statements. This is not to be mean, but I have a hard time with that. We're not victims of our normal labours. Culturally and mentally unprepared maybe. Our physiologies profoundly effected by our modern psychological and emotional landscape perhaps. But what does that mean, "I couldn't do it?" Well, yah, technically, you probably couldda. If you had been walking around in the middle of nowhere and labour came upon you and there was nowhere else to go, you'd just do it....with nobody telling you how. There would be no opportunity to say "I can't do it", you would have to. If this same labour comes upon you in modern civilization, "I can't do it" is what many women say when the crunch is on. Actually, when given the choice and available epidural, and admittedly the much more challenging birthing environment to labour in, the truer statement is "I don't want to do it." And you know what? That's perfectly okay. You are in no way, shape, or form expected to have a natural birth you don't want just because you think you should. If you didn't in the end want a natural birth when you got to active labour, it's important for the sake of your friends and daughters and women everywhere not to blame your labour for your personal choice. This desacrates the brilliance of your body, of the brilliance of the bodies of your Grandmothers. I'm not talking about situations such as inductions, or you're at 9cm for years, or you have a permacontraction that doesn't let up,or hideous back labour, or you have a PTSD reaction to a trigger, or the staff is so challenged by your coping methods that they simply drive you to distraction so you lose your mojo, or it's really long and you're truly exhausted, or there's some kind of problem, or your in laws refuse to stop wandering in and out of the room causing a case of family dystocia...these scenarios are more about survival than personal choice. I'm just talking about regular labour you decided wasn't your thing.

I feel so sad that many women think they need to apologize for their choices for pain relief and perhaps even cover up unneccessary shame by trying to convince themselves and others that their bodies were lemons for not birthing "properly" when in fact there was no problem. Maybe it means they felt they failed themselves and didn't feel as strong as their friends who had natural births. It's not a competition. Or maybe, they just really don't know what normal labour means, which is kind of a societal failure. Shouldn't girls be taught this in detail from a young age instead of know more about what celebrity was "too posh to push"? Though this choice may often be made without the correct information on benefits vs. risks of elective Cesarean and is not one I'll ever feel good about as a doula, claiming to be too posh to push is at least really honest, and the choice is totally owned with emphasis on the woman's desires for her Cesarean rather than blame on the probable birthing excellence of her body. There are very sad and misguided aspects to this choice, for sure, and it does create collective harm definitely, but at least there is no blaming or creating victimization to justify a choice.

You know, there are other ways women can experience surrender and raw power. It doesn't HAVE to be in the realm of childbirth. It's not "for" everyone. I have seen a few incredibly beautiful births, which were intensely empowering, with women whose mandate it was, for personal reasons, to feel NO pain in labour. I learned a lot from these births, and came to an honest place of honour for these women, not just paid them a lip service because I have to be diplomatic as a doula. While I may not personally agree with some choices, meaning I wouldn't choose them myself, I can totally appreciate an informed choice and ownership for that choice. Personally, if my labours felt like intense nausea instead of the way they did, I'd probably be strutting around saying, "Yeah, I had them knock me unconscious the minute I felt sick. I was simply not interested in going there. There are no benefits to my feeling that way in any circumstance in or for anybody in my life. Wanna make something of it?" Well, no, I'd probably just deal with it anyway because I believe so strongly in the benefits of natural birth. I would do my very best to heal my issues surrounding nausea. But if I did in the end make the choice to end the discomfort, I wouldn't make any apologies for myself. It is what it is.