Tuesday, January 5, 2016

Manifesto

MBC Doula School Manifesto

A doula is … a birth attendant, who provides many and varied resources for the family-to-be during the childbearing year. This was a common role from ancient times up until the 20th century, when it died out when hospital birth became the norm. Before hospitals were the places where women went to give birth, a midwife would attend a birthing woman in her own house and there was usually another woman or two, or an apprentice midwife, who would help with the extra tasks like giving the woman a back rub, or fetching warm cloths, or cooking some food, or encouraging the birthing woman when she needed it.

Back in ancient times, in some cultures, there was a circle of women who attended the birth and cared for the birthing woman carefully and with love. In other cultures, however, women birthed alone in a solitary hut and sometimes things went well and sometimes not. Romancing the past is not a good thing when it comes to the history of maternity care: maternal and neonatal mortality and morbidity rates have decreased consistently over the centuries.

Starting only about 150 years ago in the industrialized world, women started to go to hospitals to give birth. This created all sorts of problems, not least of which was massive levels of infection because medicine hadn’t yet discovered the important role that hand-washing plays in preventing infection. Just as importantly, women were going to the hospital on their own, separated from their families, and were being cared for by people they had often never met. By the mid 20th century, hospital birth had become the norm, or at least a sign of wealth, in many parts of the world.

But there were serious problems with this alienated way of giving birth, and these problems are increasing day by day. Birth in the industrialized world has become a mechanical event, monitored by machines. Increasing rates of surgical birth have led to health problems in children. The cost of birth is rising. When this model is transferred to parts of the world where the infrastructure is not sustainable, the results can be catastrophic.

In the industrialized world, those of us who bear children feel alienated from the process of birth. This alienation makes us reach out to others who can perhaps accompany us through the powerful process of giving birth. We know that the presence of another person in a birthing room, who is not emotionally connected to the birthing woman, decreases labor time, decreases requests for pain medication, and decrease the use of surgical and other interventions. This companionship gives the woman a sense of peace that enables her to look back on the experience with more satisfaction.

At the same time, in most of the industrialized world, midwives have become a very small part of the maternity care team, and the huge majority of women go to the hospital to give birth attended by medical doctors. The doula enters into this world as a companion, a guide, and an advocate but doulas do not provide maternity care for mother and baby. The doula sometimes finds herself in conflict with the recommendations put forward by the doctor or midwife, but she cannot voice her doubts. She is a companion, a vessel, an advocate.

In the early 1970’s, Klaus and Kennell were doing research on the moments after birth. They were wondering how mothers reacted to their newborns; what are the consequences of how a mother treats a baby when the baby is born. How does a mother attach to a newborn? How does the newborn react to the mother? Are there lasting effects from these few moments after birth?

Their research shed light on another interesting fact, and that was that the women who were being observed were actually affected by the presence of the observer, and if the observer was encouraging and present, the labor time was shorter and the birth was easier.

The modern doula was born. The term was appropriated from the Greek. It was a cultural appropriation that, as most linguistic borrowings are, was slightly inappropriate. The ancient Greek word that it appears to have been borrowed from means “female slave” or “handmaiden” as in “behold the Handmaiden of the lord.”

In 2003, I started a doula training program with another Montreal doula, Lesley Everest. We were already practising doulas, and we were noticing that there was a growing need for doulas in our city. Because of the particulars of maternity care in our area (large, multicultural metropolis, with a struggling infrastructure and poorly paid medical professionals), it was difficult to integrate doulas into the maternity care team. Birth abuse was common, and inexperienced doulas were often traumatized by their experiences. A short weekend workshop about normal birth, and an introduction to the basics of doula care were not enough for these doulas, and they were suffering.
Our course was an intense, comprehensive course that covered almost a full year, and included hours of class work and some shadowing opportunities.

Part of the students’ requirements included fourteen hours of volunteer time. Students started volunteering at the Montreal Diet Dispensary, which provides free food and other resources for mothers in need. They soon realized that these mothers also needed free doula services, and so the students started offering this service. Montreal Birth Companions grew from this small start.

Over the years, the partnership between Lesley and I dissolved, and I concentrated more on the volunteer organization. I was providing free training and mentorship for the volunteer doulas, as well as running a private practice. MBC grew over the years, and now provides doula care for over one hundred clients a year. That’s $100,000 at the average market price for doulas in Canada. I realized that I needed to provide a more comprehensive training for the volunteers, and I could provide MBC with eager, dedicated volunteers through\ the training program.

MBC Doula School grew from this idea. I started with a Level One doula training that provided students with the basics of doula care, enough to give them the skills to accompany a mother through her birth experience together with a partner doula. The Level One training also provided the opportunity for the students to shadow a more experienced doula, until they felt comfortable taking on a client with a partner.
Level Two is the next step, and it is much more comprehensive and gives students the skills they need to provide full care for a birthing mother throughout the childbearing year.

The next step was a natural progression that is in tune with my beliefs about education and knowledge. I provide doula students with much of my own beliefs, philosophies, and approach. They read my book and study for hours under my guidance. I wanted to open up their education by inviting other teachers and guides to provide a different voice, and more varied skills. To this end, I have invited high profile teachers from around the world, and I also invite local guest teachers who are active in the community to share their skills with the school.

I think my general philosophy about life informs my specific beliefs about birth, so I will touch on them briefly. Fundamentally, I do not believe that the particulars that make up our lives can be fully controlled by our desires or actions. As midwives say, meconium happens. However, I do strongly believe that we are responsible for our choices: it is up to us to inform ourselves, make decisions, and then live with the outcomes of those decisions in a conscious and responsible way. How does this reflect on my beliefs about birth? Essentially, I try my best to facilitate an excellent birth experience for a mother and family, and when I am the sole caregiver for that family, I take my responsibility for the safety of the mother and child very seriously. But I do not believe that the ultimate outcome is up to me. The buck does not stop with me. As the Muslims say, pray to Allah, but tie your camel to a tree. So, I interpret that to mean: do all you can, your very best, to ensure a good outcome for mother and baby, but know that all is not 100% in your hands.

Cutting-edge scientific research in the 21st century is focussing more and more on the interconnectedness of things and forces, moving away from a trend that started in the 17th century which attempted to break down the world around us into easily digestible units.
Unfortunately, modern medicine has not yet jumped into the 21st century, so we are still burdened with an understanding of the human body that sees it as a collection of pieces that function well together, but are essentially separate. As professional physicians became more a part of our lives in the industrialized world, we also lost the sense of responsibility for our own health care and tend to shift that responsibility and power to our doctors. Add to this precarious mixture a culture that is based on fear, and that uses military metaphors even to sell yogurt (“the best defense”!), and we have a birth culture that is malfunctioning and hurting families. Mothers go into the doctor’s offices afraid of birth, worried that their bodies will not work properly, believing that the doctor knows more than them, and believing without question what the doctor suggests.

My fundamental belief about childbirth is that the human body is perfectly capable, in the vast majority of cases, to give birth to a child without much help, intervention, or trauma. I believe that birth is a physiologic event that is part of the normal function of the female human body. I believe that mothers do not need lessons or techniques to learn how to give birth, but rather, that they often need to be untaught fearful or pathology-based reactions so that the body is allowed to function normally.
I believe that there are ways that a normal birth can be prepared for by the mother and expectant family. These include:
v  Effective prenatal care, including nutritional counselling, a minimum of interventive testing, informed choices throughout the process of pregnancy, labor and birth
v  Prenatal education focusing on physiologic birth, made available for the mother and partner.
v  Community support and resources readily accessible and affordable for all families.

I believe that the control of women’s bodies has been one of the essential characteristics of human life for thousands of years. It may have originated in the disturbing fact that a male could never know exactly who impregnated whom, but that is not important now. The fact that remains, however, is that we live in a culture where the fear of birth and the birthing body is paramount. All over the world, birthing women are abused and violated, usually without their consent. I believe in the value of informed choice, but I am also aware of how the “informer” can bend that information to suit their own political will.
I believe that every single time a birth unfolds without violence, the world and human society is healed a little bit.



My approach to healing and medicine is holistic, in the fundamental sense. I appreciate that most of the tools we see used in maternity care are tools that have appropriate use. While most of them should not be used routinely for every pregnancy or birth, many of them save lives when used in the right way at the right time.
Many birth practitioners make the mistake of assuming that just because something is deemed “natural”, it is fine to use it in any situation with any mother. This is not the case. Neither is it the case that more interventive tools should be used routinely. Midwives and doctors certainly need to use certain tools to monitor a pregnancy and birth. Tape measures are useful in recording the healthy progress of a pregnancy. Hands are immensely useful at all stages of pregnancy, birth and postpartum as diagnostic and healing tools, as are our senses. And of course, there is equipment of all sorts that can and should be used, or at least made available, for every pregnancy and birth.
But we don’t need to use very much equipment or procedures at all if the pregnancy or birth is progressing well and we can see (or hear) the signs of health in the mother and baby.

Education is the most effective tool at our disposal. It is, obviously, what MBC Doula School is all about! But education is much bigger than a doula school. It is every birth story you read on the social media. It’s every conversation you have in the grocery store. It’s the gruelling education that physicians endure in medical school. It’s every one of us, throughout our lives, making choices.
I believe that knowledge is a public resource. It is a vibrant source that changes with each generation, and is constantly being added to and modified. Human knowledge is what makes us human.
As our birthright, it should be shared freely. Those in the business of sharing knowledge and skills, however, need to be paid for their work, and that places knowledge within structures that can be limiting.
Education itself can be limiting, when it is bound by hierarchical, fossilized power structures. Just as the doctor/patient relationship can be one of the powerful and the powerless, so can the teacher/student relationship. When this kind of educational dynamic is established, the student gives up responsibility for active learning and ceases to question, to challenge, and to learn.

MBC Doula School grew out of my thoughts about education and birth. I was teaching a successful three-level doula training. I freely shared everything I knew with my students, for a fee. I gave them practical training and mentorship for free, and for as long as they thought they needed it. I still have former students asking my advice for their clients.
But I am just one voice, one pool of knowledge, one history. There is a whole network, in our city and in the world, of teachers who are eager to share their knowledge and skills, and MBC Doula School is a forum where they can do just that.

MBC Doula School has many students who have gone through the training and then hope to start midwifery education. My advice to them is to attend as many volunteer births as they can. There is always more to learn. It is better if every single birth teaches you something about birth. Many of the MBC Doula School students are still young. Traditionally, midwives have been older, finished with the task of raising small children. I counsel patience to these young doulas. The more births they attend as doulas, the better midwives they will become.

MBC Doula School is the child of Montreal Birth Companions. I have seen that the experience the students gain from their volunteer work with MBC makes them better prepared to enter training for many other professions, from midwifery to medicine to social work, nursing, and more.
Specifically, for students hoping to become midwives, the task of accompanying marginalized families through the childbearing year gives the student exceptionally valuable preparation for a life in midwifery. It prepares them for a life of giving; it teaches them about the medicalization of childbirth; it shows them how to accompany a mother through labor and birth using the lowest technology available (doulas do not use high-tech equipment at all, so they have to rely on their hands, their senses, and some gentle tools); it teaches them humility and cultural sensitivity.
There is a lot of discussion these days about the benefits or ethical meaning of midwives, doulas, and students traveling to poorer countries and gaining experience in birth by providing their services to the families there. There are definitely ethical problems with this model. I believe that student doulas and midwives should look closer to their own communities and focus their volunteer efforts there. There is no need to go elsewhere looking for poor people to practice on. The issue for fully trained midwives is obviously a different one, and every midwife must chose for themselves how they choose to practice. If we start to see that the world is a living, breathing entity, then we will understand that the experiences we need are often just around the corner.
In a more specific sense, the extended family of people surrounding MBC Doula School and Montreal Birth Companions have a strong sense of community, and I strive to nurture that sense. Over the next few months (by June, 2015), we will be teaming up with the Caffe della Pace to provide a physical space where students, doulas, clients, people can meet and share their stories. This community, I am hoping, will be a source of fundamental change in the birth culture in our city and hopefully part of a worldwide movement.
We are now located at the Caffe della Pace, a home for good food, good vibes, and positive change. Please come by and join us!


Thursday, September 3, 2015

Opening our Hearts

Yesterday one of our MBC mothers gave birth. We are rallying around two families right now who have nothing, not even one onesie. MBC volunteers are loving these mothers, who come from all over the world.


Montreal Birth Companions provides support, love, companionship and diapers to over 100 families every year. We do this with NO FUNDING. Every single one of my volunteers acts with love, compassion, and a deep conviction that we are all on this planet together, in the same boat, let's say.

In June of 2012, then Immigration minister Jason Kenney (succeeded by Chris Alexander) announced a series of cuts to the Interim Health Care Plan for refugees and refugee claimants. Although that legislation was recently deemed to be unconstitutional, the mess that evolved from it meant that birthing mothers that we were serving were regularly being bullied and extorted for money during they were laboring and birthing their (Canadian) babies. 

I thought that the damage done to families by our government could be assuaged by a group of committed, compassionate individuals providing loving care for people in need. 

Until a few days ago.

We have wide open spaces. We have shops brimming with goods. We have food banks. We have furniture, clothes, appliances that no one wants. We have loving people who are ready to provide assistance and guidance to families who are new here. We have jobs. We have schools. 

Let us end this culture of scarcity, where you are afraid that you won't get enough if you give something to someone else. 
Let us stop feeding the hungry ghost, and start opening our hearts and our doors to those less fortunate than ourselves.



Sunday, July 19, 2015

Trickle Down?

Let's face it ... good stuff doesn't trickle down. You have to work really hard to get the good things in life to the people who deserve them: shelter, medical care, food, clean clothes, and all of those things that many of us take for granted.

In the last ten days, I have had over ten requests from women who desperately need maternity care. I can only provide them with free doula care, from the volunteers who donate their time to Montreal Birth Companions. Some of these volunteers are students, some are experienced doulas.  But doulas don't provide medical care, and most of these women have not had prenatal care, so they are at risk for worse outcomes than the generally healthy population of our fair city.

I was called at 2:30 in the morning last week by a doula, frantic with worry. She had been called by one of our clients who was bleeding heavily. I told the doula to call 911 immediately. She did so and mother and baby survived.

Several times over the past week I have been juggling available doulas to accompany one of the MBC mothers who was laboring and needed companionship. Doulas are people too, some are on vacation, some are pregnant, most have other jobs.

I assisted at a birth where the midwives were unable to provide the mother with effective care postpartum. I was at another birth with a baby who became ill after birth. I got another call from a doula whose client was bleeding after giving birth, and the midwives had not made it to the house on time.

I have had several requests over the past few weeks from mothers who cannot find a midwife, who don't want to birth in the hospital, who are looking for an unregistered midwife. Unregistered, underground, or illegal midwives work without any medical backup and if they need to transfer their clients to the hospital, have no standing with the medical staff and are treated either as doulas or as "friends". Unregistered midwives often make calls that are not as effective as they could be - they work on a basis of mutual respect which sometimes can mean taking risks that may be dangerous and unprofessional.

I am seeing the writing on the wall, and it is telling me that we are not taking care of our mothers and babies. I can't always be there to answer the phone when a mother is in need, or a doula, (and rightly so) cannot provide medical care when there is no doctor.

Something must be done! Se non ora, quando?

Thursday, May 28, 2015

Building a Space

Over ten years ago I was in our old living room at our table, with a couple of good friends. Sharon and Sarah have moved on to better things (the music scene and soap making), but back then we were excited about the idea we shared. We had a map of Montreal spread out on the table, and Sharon had some funny stickers. We were putting the stickers around on the map, picking out places where we thought our idea would ROCK.

What was our idea? A place where we could meet with the women we serve, and a place where we could meet amongst ourselves. A place where we could gather. A place where we could have our classes and events. A home away from home.

I started looking that year, and found a tiny bookshop that was closing down (so sad! that's another story) but the rent was too much for a struggling charity/doula group. Sharon moved away, and Sarah started a different business.

I continued creating an organization that could effectively provide doula care for hundreds of families over the years, with no private or public funding, that relies on the goodness and dedication of its volunteers. With insight and determination, I persisted in spite of many setbacks. I created a doula school where many of the volunteers learn the basis of doula care, and others move on to deeper knowledge, or take workshops with visiting teachers. With the income I made from the school and from my private birth attendant activities, I felt justified putting increased hours into the volunteer program. Justified in terms of my economic responsibilities at home: I do not come from an independently wealthy household where charity can be a useful hobby.

I have been dreaming of a space for several years now. This year, everything is coming together. One of my five sons is a chef. We are opening a cafe that will serve quality vegetarian/vegan food and excellent coffees and teas.

But how does this tie in with my original dream? The foundation can be described with one word: self-sufficiency. I want to create a space where everyone can come and feel comfortable, where people can eat and drink together, and speak different languages, and learn about different things. But spaces aren't free, and grants were not forthcoming. So we took out a personal loan, found a place with cheap rent, rolled up our sleeves and got to work. We renovated, painted, and hauled. We bought second hand equipment. My chef learned how to do electricals. We all pitched in and built, sanded, stained and varnished the counters and tables. A friend sewed us some curtains. Another friend designed us a logo. We scrimped and saved and worked hard and .... we are almost there, opening soon, a home for whomever wants to visit.

Caffe della Pace means the Peace Cafe in English. Come and visit next time you are in the neighbourhood!

Sunday, February 22, 2015

Witches

Hard on the heels of news of a very disturbing trend in Spain came one of the most amazing births I have ever been honored to attend. So, I think two posts will have to be written, and I am working hard on absorbing and learning everything I have been experiencing in the past week.

First, the disturbing news. Many of us in the birth world, especially in Europe, have read about the Spanish association of nurses' official report on doulas. This report apparently took a couple of years to compile. It is an attack on the doula in general, and contains some specific accusations against certain doulas in Spain who may be identifiable (only to themselves and close friends).

The document contains some bizarre accusations: that doulas divide families, that they practice cannibalism, that they condone obstetric violence. Because of the bizarre nature of some of the accusations, several critics have suggested we just ignore it as a childish outburst and get on with promoting natural childbirth, and the doulas and midwives who facilitate it.

I don't agree. I believe this report has all the trappings of a witch hunt: the exaggerations, the caricatures, the false accusations, the violence, and the "scientific" pretensions. These campaigns are usually driven by fear and ignorance but at this point I am not really interested in figuring out why, I just want people to recognize that this is important, and must be publicly spoken out against, as soon as possible.

I know that Spain is a country with a long history of persecution and accusation. The Spanish General Nursing Council should be more sensitive to the precedents set by Spain's leaders throughout history, who have shown little ability to look at the facts and make informed decisions. From the Spanish monarchy in the 15th century, who have the dubious reputation of persecuting the Muslims in their midst, burning and deporting the Jews in 1492, then sailing off to new climes to kill and destroy ancient civilizations, through to modern times, when the country rose in flames to kill each other, and lived through a brutal dictatorship right up until the nineteen seventies... Spain has not been a peaceful land. 

We believe, as Birth Keepers, that gentle birth is the way forward for peace on earth. I believe that a renewed campaign against gentle birth keepers is a campaign against peace. It's a campaign against those who are trying to change our abusive, violent birth machine into a place where people of all kinds can birth their babies and their futures.

You may say I am sensationalizing. I know that there were Jews in Berlin who were also accused of sensationalizing when they tried to tell their people to leave. You may say I'm drawing the wrong parallels. I know there is a child in a Spanish orphanage right now whose mother had a home birth with an independent midwife. 

Just last year, an Italian midwife was docked six months of work for teaching a doula training class: 

The accusation against her is that of having violated the Professional Code of Conduct of Midwives by her participation as instructor during instruction courses for birth support personnel known as doulas (defined on that occasion as “persons capable of damaging the health of women and infants”).We would like to take this occasion to communicate that the Professional Code of Conduct of Midwives includes the provision that it is within their scope to provide training for support personnel (art 2.4). The sentence, besides being extremely serious in itself and for the midwife concerned, also casts a shadow over the figure of the doula (cited and recognized as a support person for women in the Care in normal Birth, by WHO – ed. 1996; par 2.5 – and cited in the recent Guidelines to caesarean sections by the Italian Ministry of Health, ed. 2012, pg. 80-82), creating a precedent which we would like to bring to the urgent attention of doctors, midwives, doulas and parents. We wish that this case is brought to the attention of all birth personnel in Europe and the rest of the world." private message, May 26, 2014.

The fact that these accusations are surfacing again, in a different country, is very serious. Europe is a volatile place and the witch hunt against doulas and independent midwives could spread. The campaign could move from bizarre 25 page reports to different types of accusations and investigations. I am not saying this to make people afraid; rather, I am suggesting we should not act out of fear and try to hush things up, worrying that we will be spreading the word that doulas are to be avoided. I am suggesting that we take full action, as full as possible, so that this witch hunt doesn't spread any further. 

What to do?


  • Make a circle: Doulas and Birth Keepers of all kinds need to pull together and stop squabbling. In each country, we need to see a strong organization that represents ALL doulas, no matter where they trained or how they are certified (for example, see Association Québécoise des Accompagnantes à la Naissance).
  • Attend births! Educate birthing mothers! Educate the public! Provide doula support to families during the childbearing year! Flood the social media with images and stories of gentle birth!
In the spirit of real birth, gentle Birth Keepers, and moving forward to a peaceful world, let's reach out to each other and be the change we all need.









Wednesday, February 11, 2015

Losing Your Self

Back in the fall, I went to a birth. It was the first birth I'd been to in a long time. It was wonderful! But it was very different from how I imagined it would be.

I always love the feeling that I am doing exactly what I was meant to do: accompany women during childbirth. The most important lesson about birth is that it is very much like life: you can't really plan for it. Meconium happens. Stuff gets broken. People get lost. Suddenly you turn a corner and there is the most beautiful sunset you've ever seen.

Here is a picture of an obstetrician waiting for an unsuspecting pregnant woman. She is being pulled along to the birthing room by her husband...dropping her slipper like Cinderella...he is rushing to punch the clock ... I'm late! I'm late!

The doctor holds a limp pair of forceps in his hand. He is going to get this baby out, for once and for all!!!


Of course, birth doesn't usually happen according to our plans, or according to anyone's schedule or hourly rate. Babies come when they want, or when they need to leave their mother's womb, or when the womb needs to expel them. Who knows. But they don't generally show up when we plan for them to.

And then when they do, the birth unfolds in a different way from what people had been expecting or planning. Which is why I still don't believe that birth plans are useful. Not because birth shouldn't be thought about and considered deeply, that choices shouldn't be made about where you want to give birth and with which people around you. But because the unfolding of your birth experience, of any birth experience, is unpredictable and can't - shouldn't - be pinned down. Because if you try to capture it with a plan, you could miss out on something extraordinary that you hadn't thought about, that couldn't be contained by your plan.

So, what does that mean for us attendants? How do we plan our days and our lives? 

Birth attendants are often on call day and night. Doulas may be on call for months at a time, unless they structure their work effectively by creating a doula collective which involves sharing care. But most doula clients want the continuity of care that means that one doula is always available. So there go your plans for family events, sleep, trips....

But in a deeper sense, when you are actually attending a birth, when the labouring woman is there deeply in the process of birth, then what? Are you thinking about what groceries you are going to buy tomorrow? No, you are with the labouring woman. You are providing support for her and her family, her partner, whomever. Even if you are sitting in a comfy chair knitting: your intention, your senses, your compassion, your heart and all of your focus are bound up with the birth process and the safe place you are creating for the newborn family to move through.

And then you lose yourself. You forget about your worries, strengths, failures, envies, moods. Your only task is to serve birth. You are serving the woman as she moves through her experience of birth, as she becomes a mother. And are you the most important person in the room? Is the obstetrician the buck upon which stuff stops? Of course not. The most important people in the birth room are: the mother and the baby. And how they are treated by everyone else is the most important aspect of the whole process. So, the less we all worry about ourselves, and the more we focus, truly focus, upon the family-to-be, the better off everyone will be in the end. Losing yourself is just the beginning!




Thursday, January 8, 2015

The Shaming of Mothers

More and more evidence is coming out about the dangers of cesarean section. Every time I scroll through my birthy friends' Facebook posts, I see another mega-study that confirms what we knew all along: c-sections are dangerous. Of course, this surgery can and does save lives. But it cannot be true that over one quarter of our childbearing population can't deliver vaginally. 

I believe that for a well-fed, healthy population such as ours in the industrialized worlds, the necessary c-section rate should hover around 5%. Do the math: this means that at least one in five women are suffering unnecessary surgery. This surgery sets the tone for a woman's mothering - it isn't always a traumatic event, but it definitely is a physical handicap and a hurdle that many mothers would rather not have to face. 

I don't want to write about the reasons for these unnecessary trips to the operating theatre; the reasons are varied and complicated. I DO want to talk about how we are making women feel when we constantly post about the dangers, risks, and unredeemable damage caused by cesarean section.

Giant study links C-sections with chronic disorders 


Let's shout it out and make women feel really bad about how they birthed their babies. Let's make them feel even worse about an unexpected c-section than they already do. While we're at it, let's talk about how to have a VBAC: all you need is perseverance, inner peace, and you have to be in tune with your body. Right?

Women are having c-sections they don't want. Women are going to the hospital, sometimes with a doula and sometimes (usually) not, and they find at a certain point in their labor that they are not performing well enough, and they are scooted down to the OR. Most women do not want surgery. Most women want a vaginal birth. Many women want to have a vaginal birth even after a c-section. Just one VBAC support group on Facebook has 8,796 members. 

I am asking all of you to spread the word to not spread the word about how damaging c-sections are. Women who have had an unwanted cesarean birth KNOW that they are damaging. Let's try a little tenderness and spread the word instead about loving the mother, home birth, undisturbed birth, midwifery care, all the good things....




Monday, January 5, 2015

Law Abiding Midwives

We humans have a tradition of honoring the midwife, one way or another, or at least we have ways to remember her and tell our children about her. Whether she is La Befana, who comes on the night of January 5th to deliver gifts to Italian children, or a kindly grandma, we remember her and she is always at the back of our consciousness, for better or for worse.

In the Jewish tradition, we tell the story of the two midwives Shifra and Puah, who worked illegally to continue to assist women giving birth, during the time of the oppression of the Jewish people in Egypt. They refused to obey the Pharoah's command, which was to kill the boy babies. When Pharoah questioned them, they gave him an answer that he couldn't refute, that the women delivered so quickly they couldn't catch the boys to kill them.

That sounds like an illegal midwife's story: when she has to transport a client to the hospital, she lies and says she was "just" the doula, and that the baby came so quickly that she didn't know what to do.

Midwives have been feared. We've been targeted, killed, oppressed, abused... we have been painted as the old lady with large warts who rides a broomstick and eats toads. We were burned as heretics and witches during various periods of human history. We've got magic in our hands, that's certain: we know about birth, life and death ... we know how to comfort a woman who seems like she's dying, and we can heal a child with herbs and loving care. 

In one obscure tradition from the Book of Enoch, some angels were looking down and they fell in love with human women. They got together and fell to earth, had sex with the women and exchanged with them the knowledge of fire, herbal healing, and magic. 
And all the others together with them took unto themselves wives, and each chose for himself one, and they began to go in unto them and to defile themselves with them, and they taught them charms and enchantments, and the cutting of roots, and made them acquainted with plants. And they became pregnant, and they bare great giants.
coltsfoot

Midwives have a great tradition of teaching through apprenticeship. We believe that book learning is a wonderful thing, indeed, the knowledge we have instantly at our fingertips is truly marvellous. The scientific method is an absolutely necessary tool that midwives need to know how to use. But there is nothing to compare to the knowledge that an apprentice gains by witnessing her mentor at work. She learns by watching, listening, using all her senses and intuitions to understand and absorb the skill and art of midwifery.


Midwives accompany women on their birth journey, knowing that it is not always orgasmic and fun. We know how to spot a small dark cloud on the horizon, and when to intervene, and when to send a woman to the hospital, if such a thing exists where we are practising. I recently heard a commentary on natural birth: "Fuck! This is horrible!". She birthed about a half hour later. The pain was immense, no drugs were given, she thought she was going to die, and didn't believe us when we told her otherwise. She birthed, and will always remember how strong she was.

Midwifery is now taught in universities in much of the western world. Graduate midwives then are licensed and controlled by state rules and establishment guidelines. These guidelines are not midwifery guidelines, necessarily. Some of them are in place to help midwives save lives, but others are not. Midwives are put in a difficult position of having to make decisions that go against their knowledge, intuition and skills so that they are not penalized or ostracized by their peers.

I have followed a crooked, witchy path to midwifery, that included being taught by many, many wise women and a few wise men.

Here is a Solstice shout out to the original illegal midwives, Shifra and Puah, and to all the women I know who are practising honest midwifery in the here and now.... you know who you are!





Tuesday, December 23, 2014

Home Birth and Home Death


Babies sometimes just pop earthside but mostly birthing women want to have some company when they are going through this earth-shaking, phenomenally life-changing event.

I was born with a natural talent to accompany women through their birth journeys. I don't even know what I do most of the time but women tell me they feel better when I am present and quietly witnessing their changes. I tell them that everything is fine. I comfort. I nourish. It's just part of me, hey? I am not writing this because I am clapping my own hand.

When a person sees the woman they love looking like she's probably going to die, because her eyes have gone all weird and she's kind of fainting, they feel better when I tell them that this is normal, she is tripping in a special, life-giving way.

And it is truly magical if this event can take place at home. At home, a woman can run through her whole labor process in her own space. She can barf in her own garbage can. She can make love with her partner in her own living room. She can crawl backwards to the fridge to get apple juice.

She can give birth herself, surrounded by people who love her. She can cuddle with her new child in her own room, and she doesn't need a car seat.

I had a friend back in my hippie organic farming days: she had a c-section for her first child because she was breech, so she had her second on her own. She sent her husband and daughter off for a long walk (!), made sure she had enough methergine from the goat's birth kit, and birthed alone. She told me it was frightening. She would have wanted to have a midwife present, and so the third time around, she invited a midwife along for the ride.

Some women freebirth. These are women who birth on their own or with their partner and children. They trust the birth process implicitly and do not believe they need a midwife. Many women who wish to give birth at home do want a midwife, and midwives are generally respectful of the birth process and knowledgeable about serious challenges, even life-threatening ones, that very rarely unfold during birth.


Right now, in Canada, there is an ongoing discussion about end-of-life care. Many people are suggesting that death moves back home. This sounds all warm and fuzzy but let's look at the reality of this phenomenon.

First of all, I wonder why we are not talking more about bringing birth home? Is the dollar playing a part in this discussion? Possibly. It takes a couple of days, max, to have a baby. Midwifery is an economically viable option if you look at the bigger picture of health care in our country. The women giving birth in our country are, in the huge majority of cases, healthy and well-nourished. Group prenatal classes are popular and prenatal visits are easy to schedule.
Even when birthing women give birth in the hospital, where physicians can make their salaries and the women's hospital stay is almost always less than four days, birth costs less than death.

Dying takes a lot longer. Palliative care can be offloaded to families, private nurses, volunteer organizations and the occasional medical professional for the weeks or months before the final days.

Birth at home is a joy, a beginning, it is a moment that is too short to comprehend, passing in the blink of an eye.

Death at home can take weeks, even months. The family can implode, or explode. Money becomes scarce, life can enter a fog. When the final days come, they can be full of body fluids that no one wanted to deal with, disturbing images that no one can forget, emotional moments better left unspoken. I wonder why people think that birth is "too messy", and they romantically envision themselves dying peacefully surrounded by their loved ones? Have we so lost touch with reality that we think that dying in bed is like in a TV show, where the patient just slips away in the arms of her loyal husband? And the nurses stand around the bed with tears in their eyes?

Death can be just as messy as birth, and often is. I have attended many "clean" births, where the baby is born to a minimum of amniotic fluid, blood, poop, and vernix. But some births are bloody. Some births are full of waters. Some are so astoundingly shit-filled you wonder if it was intended divine humor. Some births have a little bit of everything: vomit, stool, meconium, urine, amniotic fluid, blood ...

People I have spoken to who felt that their relative's home death was a good experience were people who could afford to have a private care giver who was discreetly present for the family, or they were well acquainted with the body and its many processes. Others felt that the family was ill-equipped to deal with the physical death of their relative, as they were going through difficult emotional issues, perhaps complicated ones, and the physical realities were hard-hitting.

I thought I was well equipped to accompany my mother through her dying hours. I had nursed my father for the months he was bed-ridden, and I feel confident in my relationship with bodies.

I was wrong. The constant pain was so difficult for me to bear. I was voted as the family member best equipped to administer morphine. I didn't know if it was the right thing to do, even though I did it every two hours for a couple of days. I was the one who changed the pads. So much liquid! Who knew that the body basically dissolves at death. It wasn't urine. It wasn't amniotic fluid. It was vital fluid, leaking and leaking. Every time I changed the pad it was like torture, for me and for her. I was the one who tried everything to counter the pain of oral thrush. Did you know that this is a sign of the end of life? I have assisted many mothers through the intensity of vaginal, breast, and newborn thrush but this was above, beyond and off the charts pain for the woman who gave birth to me. She couldn't eat. She couldn't drink. All she wanted was a big tall glass of water. She was listening to the poetry in her head. She said that there were raucous voices shouting out her poetry. We put on her favourite music. She breathed very loudly. Even now I awake with a start, hearing that noise. Her body was in pain, the morphine didn't quite cut it.

In the end, the last words she said were: "Is it my birthday today?"

It was a good death, as death goes.

But, please, don't sugarcoat dying at home. Don't be led by the nose to doing something alone that should be an event where there are people present who know what is supposed to happen: Yes, this is normal. Yes, take a break for a little while. Yes, let's let her go. No, the morphine isn't killing her.

A sane culture is one where babies are born at home, where midwives are discreetly present for the woman, her newborn, and her family. A sane culture is one where people can die at home, where death midwives are present for the dying, for the living, and for the continuity of the family and the community.

Tuesday, November 11, 2014

My Dream

Since I first started working with women here in Montreal I have been dreaming of opening a space where we could gather, with each other, with our babies, with our friends, spouses, partners, with our doulas ... or where a woman could come and just sit and read a book or stare into space.

Now I am finally at the point where this dream can become a reality. My last big project is done - I finally got my CPM certification last year. I have good contacts and solid friendships here so I feel like I may stick around for a while ... and it looks like with a lot of work and a good dose of luck, I might be able to see this dream become a reality.

I am hoping to raise a little money to help out for my first year. I have put up a campaign on Indiegogo - please have a look at it. If you could contribute ten dollars to this amazing vision, and share the campaign with all of your friends, I would be so happy! Please click on my dream to read more.

My Dream

Thursday, November 6, 2014

#beenrapedneverreported

I am sure there are women all over Canada who have suddenly started to think about things that they perhaps hadn't thought about for years, or months at least.

I am thinking about this snarly little word: consensual.

Consensual, the word, has roots in Latin: con means "with" and sensual comes from "sentire" which means "to feel". So, you feel with another person.

Many women get raped and don't go to the police: they don't want to get dragged through court; they are ashamed (do you feel ashamed when your bicycle gets stolen?); they are too damn busy; and some of us don't report because we are hung up on this little consensual word. Because lots of rapes aren't like the masked stranger jumps out of the bushes at the unsuspecting Good Girl. Most rapes are, well, you're out drinking with the guys and the asshole who takes you home.... or, you're a young woman and don't yet know how to say "no" to a powerful relative.... or, you want to get ahead in your job so....

I didn't report, why would I?

Because we aren't taught that if you don't want it, it doesn't happen. We are taught that if you don't want it, there must be something wrong with you. If you don't want sex, or this kind of sex, or sex right now. If you don't want to put your baby in daycare, or you do want to, or you don't want to breastfeed, or you do want to, or you don't want to have an epidural or you do....

We're taught that if you report, you have a problem. If someone in power (your uncle, or your boss) wants to have sex with you, suck it up!

And not only that, we are taught that we have to be the best we can be, we have to have "my best birth" (hard if you were screwed by your uncle as a child), we have to "suck it up" (sucker!), look good, talk loud (don't be shy!), work hard, play hard AND clean the house...


So let's start treating ourselves with a little bit more respect. Let's say no when we mean no, and let's teach our children about the difference between yes and no. Yes means YES. No means NO. When I say YES, I am saying it because I mean it! Yes, I want to have sex. Yes, I want an epidural. No, I don't want to clean the bathroom right now. Yes, I want to breast feed. No, I do not want to make love right now. No, I do not want to cook supper tonight. No, I do not want an epidural or an induction. No, I want to go out on my own tonight. Yes, I would like to have an hour off. No, I am not going to keep quiet for forty years because I feel so ashamed. Yes, in fact, I AM going to clean the damn toilet right now because its filthy. Yes, I DO want a cesarean. Yes, I AM going to have an abortion. Yes, I AM going to have another child. I am going to go to law school. I am going to be a mom. I am. I am. I am.

Thursday, October 2, 2014

Dare to Care Workshop

I am looking forward to presenting my "Dare to Care" workshop in Saskatoon in November. I am going there anyway to speak at the Canadian Association of Midwives 2014 conference. I will be speaking about about the good sense of requiring midwifery applicants to have experience as volunteer doulas, in an organization such as Montreal Birth Companions.

When I decided I would indeed be going back to Saskatoon (I was there ... 40 years ago as a young hippie girl), I contacted my virtual friend Lisa Wass, a Birth Keeper who is director of Birth Rhythms. Birth Rhythms is the kind of place you would imagine finding in a large metropolitan city, but there it is in Saskatoon, changing women's, babies' and families' lives for the better every day (and every night - Lisa is also a doula who attends births).

I am very honored to be presenting my workshop there - it is a little bit of a transition time for Birth Rhythms and Lisa's community has banded together and shown their absolute support for this amazing organization.

"Dare to Care" is a workshop that focuses on the healing power of birth, and on self care and pleasure for the Birth Keeper. We will be exploring different approaches to healing, and we will be playing together with some body mapping techniques and storytelling.

For more information, head over to Birth Rhythms and look at their calendar here.


Wednesday, October 1, 2014

Birth Drugs


Just say no? Of course not!

Drugs save people's lives. Antibiotics, antiretrovirals, opiates, anesthetics, statins .... the list goes on and on. Every day, millions of people are kept alive by modern medicine and by appropriately prescribed medication.
In obstetrics, however, as in psychiatry, medications are overused and used inappropriately. The other day I heard a story about a woman who needed surgery like she needed a hole in the head. She is alone, poor, and anxious. She was going to have a difficult entry into motherhood without major surgery, dealing with the stress of a newborn along with the continued stresses of poverty and cultural isolation.
She was scheduled for an induction and her uterus reacted too strongly to a Cervidil insertion and started hyper-contracting. Baby went into distress and surgery was needed to save the baby. 
I would need a crystal ball and a full-on fortune telling kit to figure out if this particular mother-baby dyad would have needed surgery if left alone. But it is true that "Care providers need to consider that induction of women with an unfavourable cervix is associated with a higher failure rate in nulliparous patients and a higher Caesarean section rate in nulliparous and parous patients" (SOGC).

Why are we giving drugs to laboring women? I took a picture of this drug the other day. It is called synthetic oxytocin. It can save women's lives if they are experiencing a serious postpartum hemorrhage. But it is used much too often to speed up or stimulate labor in cases where a good dose of patience is all that is called for.


This is a high risk drug!

Another cocktail of drugs that is commonly administered is the epidural cocktail. The components vary from hospital to hospital. You can find detailed information on the most common ingredients here (page 20). Most epidurals do contain Fentanyl (see below), which is an opiate. I have never heard an anesthesiologist ask a laboring woman if she has a history of substance addiction, but most recovered addicts I know would not willing put an opiate into their bodies unless they really had to.

Which leads me to the next question, which is: when is it necessary to give pharmaceutical medication to women in labor? And I would like to suggest that the answer should be: when the pharmaceuticals are directly involved in saving the life of mother or baby or both. 

We simply do not know the long-term effects of epidural medication on the baby.  And no, I am not speaking from a pedestal of wonderful candle-lit home births here, either. I have experienced my fair share of birth trauma. And yes, I am fully aware that taking an epidural during labor is often very important for the woman's emotional and psychological well-being, and her sense of empowerment. But these drugs are becoming normalized and their effects minimized. I would like to see the brake put on this candy store mentality where we are offering dangerous drugs to women and newborns.

Here is a brief description of one of these candies:

Molecular structure of fentanyl
Fentanyl is a powerful synthetic opiate analgesic similar to but more potent than morphine. It is typically used to treat patients with severe pain, or to manage pain after surgery. It is also sometimes used to treat people with chronic pain who are physically tolerant to opiates. It is a schedule II prescription drug.
In its prescription form, fentanyl is known as Actiq, Duragesic, and Sublimaze. Street names for the drug include Apache, China girl, China white, dance fever, friend, goodfella, jackpot, murder 8, TNT, as well as Tango and Cash.
Like heroin, morphine, and other opioid drugs, fentanyl works by binding to the body's opiate receptors, highly concentrated in areas of the brain that control pain and emotions. When opiate drugs bind to these receptors, they can drive up dopamine levels in the brain's reward areas, producing a state of euphoria and relaxation. Medications called opiate receptor antagonists act by blocking the effects of opiate drugs. Naloxone is one such antagonist. Overdoses of fentanyl should be treated immediately with an opiate antagonist.When prescribed by a physician, fentanyl is often administered via injection, transdermal patch, or in lozenge form. However, the type of fentanyl associated with recent overdoses was produced in clandestine laboratories and mixed with (or substituted for) heroin in a powder form. Mixing fentanyl with street-sold heroin or cocaine markedly amplifies their potency and potential dangers. Effects include: euphoria, drowsiness/respiratory depression and arrest, nausea, confusion, constipation, sedation, unconsciousness, coma, tolerance, and addiction. (National Institute of Drug Abuse (2012). Fentanyl Retrieved from http://www.drugabuse.gov/drugs-abuse/fentanyl on September 23, 2014)

Tuesday, September 16, 2014

Midwifery and Doula Work

I just found out that another student graduate of the MBC Doula School has been accepted into Ryerson midwifery school. She will make a wonderful midwife and I truly believe that the experience she has had volunteering for Montreal Birth Companions has given her the groundwork that she needs to start her midwifery education with confidence and compassion.

I have been involved in maternity care since I was thirteen, which as my youngest son likes to point out, was a very long time ago! For years, when my four older children were small and I was running an organic subsistence farm, I studied Clara Hartley's "Apprentice Academics" long-distance midwifery courses, and so I gained my theoretical background for woman-centered care. When I returned to Canada, I chose to attend births as a doula and I continued to learn from every woman I accompanied, and from every professional I met.

I have been part of programs that offer midwifery internships to students in parts of the world where midwives is scarce and hospitals are under-equipped and expensive. This phenomenon morphed into programs in the southern US that provide midwife-based maternity care to Mexican women, and it also became a popular way for student midwives from the US to "get their numbers" for the Certified Professional Midwife program administered by NARM. This practice has now been discontinued because of ethical considerations, which makes it even more difficult for midwifery students from North America to have contact with women from cultures outside of their own. 

Midwifery programs in Canada are not apprentice-based, and the university programs that teach Canadian midwives do not expect students to go to the community to gather their birth experience. Practical experience is combined with theoretical study to provide the students with a grounding in midwifery in Canada. 

The requirements for graduation vary slightly from province to province, but generally a graduate midwife must have attended "a minimum of 60 births, acting as primary caregiver for at least 40 births in home and hospital settings." (http://www.ryerson.ca/midwifery/overview.html)

A student midwife can learn a lot from participating in the births of 60 babies. As every birth is different, the student will see, hear and learn about many variations to the tune of giving birth. If she is primary caregiver for 40 births, hopefully she will attend ten home births, and possibly have to transfer one of those to the hospital.

But I propose that prospective midwifery students in Canada and around the world can greatly benefit from a foundation of learning and experience that they will find by volunteering as doulas for needy women.

Why? 

First, volunteering as a doula can teach a midwifery student about an important aspect of midwifery, an aspect that is not taught in class and can only be learned in practice - and even better in doula practice! This is the art of sitting on your hands: "Don't just do something - sit there!" is one of the golden rules of being a true Birth Keeper. Doulas working in hospitals alongside medically trained professionals need to be able to keep their opinions to themselves. They need to learn how to act diplomatically in all sorts of situations. They need to learn how to comfort, how to heal, how to facilitate natural birth with only the lowest technologies. They learn how to measure cervical dilation with their eyes and ears. They can distinguish between normal pain in labor and suffering. They are adept at hearing the little catch in the breath at the peak of a contraction that means that a woman is nearing the pushing phase. They can sense the difference between the "6 cm rectal pressure" (when a woman probably just needs to have a poo); and the fully dilated deep pushing urge.

Why are these skills important for a midwife? Because the art of midwifery rests on a foundation of physiological childbirth. And the more a midwife knows about how NOT to disturb the birthing process, the easier her task will be. Then when she starts her midwifery classes, which teach her the skills that doulas are not trained in, she will already have the very basics of birth attendance.

Secondly, as a volunteer doula with an organization such as MBC, the midwife-to-be will come into contact with women from many backgrounds. She will witness birth experiences that will be as different from each other as every woman's story. She will find herself listening to women's stories from around the world, and she will learn about herself as a woman and as a birth companion. She will learn about professional boundaries, and about the challenges that women face when they are marginalized.

As a Birth Keeper, I have witnessed many births and I have been part of many more, as coordinator of MBC, as shoulder to cry on, as mentor. I have learned from books and from my teachers (Basia, Ibu Robin, Heather, and others). I have learned what NOT to do from other teachers - and those I won't name - but I have witnessed midwives, nurses and physicians who have treated birthing women with disrespect and brutality. 

But the most I have learned has been from the birthing women I have served. And this is why I believe that volunteering with an organization such as Montreal Birth Companions should not be an aid to midwifery school acceptance, but a requirement.




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