Baby Cutting

"It's just a little cut. Baby won't feel it." Does that sounds familiar? 

I sit in friendly silence so many times when midwives from various cultural places and bases are discussing male circumcision. I've learned over the years that when religion and emotions meet, its better to keep silent. 

But I am surprised and - yes - shocked to see the epidemic of frenotomies and the over-diagnosing of ankylglossia - commonly known as "tongue-tie".

In researching this subject, I found some sites and articles that suggested that the incidence of ankylglossia was about 10%. The suggestion is made that if this condition is not cured when the infant is very young, it could lead to speech and digestive problems when the child is older. But that can't mean that 10% of the population needed to be cut! We do have a pretty sophisticated system of communication, called language, that most of us can manage with quite effectively.

I found a critical summary of research done up to 2004 in a nice online journal that focuses on evidence-based medecine. The studies they looked at came up with an incidence of 1-4%, which is still hefty, but not unreasonable. It is suggested that frenotomy definitely helps reduce maternal pain during breastfeeding. The conclusion that is drawn, however, is that "...in the main this appears to be one of those areas where there is much opinion but little evidence. A much more thorough review [7] concludes that controversy is fuelled by lack of good information about intervention. It is surprising that there is not more good information. Ankyloglossia is not rare, affecting one to four babies in every 100. There is a congenital component, but we know little about other possible associations, except possibly with cocaine use in pregnancy. Clearly there is a need for more research, which need be neither expensive nor complicated. Less opinion, please, and more evidence. A great topic for postgraduate qualifications and the tongue-tied." (http://www.medicine.ox.ac.uk/bandolier/band124/b124-2.html)

A more recent study shows that indeed, nipple pain is significantly reduced and breastfeeding satisfaction is higher when frenotomy is performed on "...infants with signficant ankyloglossia". (http://jgh.ca/uploads/breastfeeding/aaptonguetie2004.pdf

On the other hand, " ...ankyloglossia is relatively uncommon in the newborn population, but inspection of the tongue and its function should be part of the routine neonatal examination. Most of the time, ankyloglossia is an anatomical finding without significant consequences for the newborn or infant affected by this condition. Current evidence seems to demonstrate that despite ankyloglossia, most newborns are able to breastfeed successfully". (http://www.cps.ca/en/documents/position/ankyloglossia-breastfeeding).

No one is arguing that severe ankylglossia will not lead to breastfeeding problems including nipple damage and pain; reduced intake, and a possible consequent failure to thrive. 

However, I am seeing the current approach as akin to the movement towards "routine" circumcision in the U.S. in the post-war years. I assume that the rationalization was based on an understanding of cleanliness and hygiene, and possibly to limit the spread of STDs (with the men just back from a series of battlefields, could that have been a concern?). 

Routine circumcision peaked in the U.S. during the sixties, when up to 90% of boys were circumcised, from around 30% in the thirties. (http://www.circs.org/index.php/Reviews/Rates/USA) 

In the U.K., the rate of circumcision due to diagnosed phimosis was under 5% in the 80's, and even this low rate has been criticized. It has since dropped appreciably, because of a better understanding of true phimosis and an improved diagnostic approach: "...The decline is attributed to the increased use of evidence-based medicine". (http://www.cirp.org/library/treatment/phimosis/rickwood2/ ) It has been dropping consistently in Canada, with most provincial health care plans delisting it. The average rate in Canada in 2006/7 was just over 30%. (http://en.wikipedia.org/wiki/Prevalence_of_circumcision#Canada)

Are we going to have another pendulum swing in thirty years, when we realize that we have been unnecessarily cutting the second most sensitive part of our babies' bodies for absolutely no reason?

When I was interning in Bali last year, at the Yayasan Bumi Sehat, I had an experience that taught me an important lesson about breastfeeding. I came in for my shift at 6am and the intern who was leaving let me know that there was a postpartum woman in one of the beds who was having serious difficulties breastfeeding. The intern was frustrated and worried, and asked me if I could find a way to let the mother know that she needed to be proactive about feeding her baby. 

The woman was twelve hours postpartum, and she was lying on her side on a low bed in the postpartum room. She was wrapped in a sarong but her breasts were bare, and the baby just had a cloth diaper covering his bum. Her breasts were not the best. They were large, with little tone, and her nipples were deeply inverted. I greeted her and asked how she was doing, she was doing well, she had eaten, everything was fine. I asked if I could sit with her. I sat next to the bed and kept my hands to myself. I wanted to get the baby's head, and stimulate her nipple, and put two and two together. But I didn't.

In Bali, you see a lot of people sitting around. People aren't frantically doing stuff like we do. They hang around and shoot the breeze.

I got her some water. Then I sat back down. Other people came in and out. I stayed. She put the baby on and took him off for about two hours, until finally he was well latched and sucking vigorously. 

This baby continued to thrive. I continue to sit on my hands and provide support. Certainly, we have mothers and babies who are not well: mothers get sick; babies have anomalies; breasts (very rarely) don't produce milk. 

If it ain't broke, don't fix it. Don't even try.

Birth and Political Theory?

One of my students has generously agreed to let me post her paper on classical feminism, patriarchy and birth. Read on!

Women as well as men have been discussing the various ramifications of patriarchy and sexism for quite awhile now. A lot of thought has gone into strategy on how to best fight it. However, the root cause often goes unquestioned by those discussing the effects. Some prominent thinkers have attempted to discover the root. Simone de Beauvoir, for example, states that the fundamental reason for women's oppression is her enslavement to the reproductive function. I agree. The female identity is formed not only in a reproductive body but in largely unexamined preconceived notions about that body. As Mary O’Brien, a political theorist and midwife, clearly puts it: the unexamined reproductive process  is the sturdiest plank in the platform of male supremacy.

So where did these preconceived notions come from? Both Beauvoir and O’Brien believe that there was a historical moment that catalyzed patriarchy.They explain that in realizing the reality of paternity and the male contribution to the reproductive process, men created systems in which they could control the process of reproduction. In patriarchy, female reproductive processes are defined by men.These processes, including menstruation, gestation and birth,  have been deemed not only scientifically uninteresting, but have also been mystified as the unknown, the strange, and even the grotesque.

This patriarchal view has clearly permeated the female view of her own body’s function. Even Simone de Beauvoir writes that the mother “is the prey of the species, which imposes its mysterious laws upon her, and as a rule this subjection to strange outer forces frightens her, her fright being manifested in morning sickness and nausea” .To Beauvoir, nursing is “the species gnawing at their vitals.”

Beauvoir, despite her great strides for feminism at her time, does not rethink the significance of the motherhood holistically and outside of male formed systems. Therefore, she, like the rest of patriarchal thinkers, denies the possibility of motherhood as a meaningful and authentic factor of a woman’s identity.  Once we acknowledge that commonly held views on motherhood are not universal truths, we can begin to accept the idea that the female reproductive process gives women a unique connection to the body, cyclic nature, and continuity.

The concept of being pregnant, and experiencing the evolution of having another identity within your body can be an enlightening experience, in which the concept of inner and outer, self and other, become blurred and questioned. In gestation and birth, women engage with the mind-body dualism in a way that is uniquely female.

The poet Adrienne Rich asserts that “patriarchal thought has limited female biology to its own narrow specifications.... in order to live a fully human life we require not only control of our bodies; we must touch the unity and resonance of our physicality, our bond with the natural order, the corporeal ground of our intelligence.” The intelligence and transcendence experienced by mothers that Beauvoir calls an illusion, Rich believes to be a consciousness outside of the narrow specifications of patriarchal thought.

Beauvoir along with other intellectual 20th century feminists are quick to acknowledge the disempowering, enslaving, and unpleasant elements of motherhood in contrast to the stereotypically male roles. Motherhood can be boring. It can be tedious and exhausting. Enslavement to any one role without choice or agency should be fought against, but motherhood is not intrinsically this, despite how patriarchal norms have defined it. There is the real possibility for a powerful female identity that has gone overlooked.

 If the process of reproduction from conception to gestation to birth  is understood, women can form for themselves an identity that experiences authentic creation in reproduction. The identity is formed by accepting the lack of control and the inevitability of repetition in life, by connecting to and understanding the body, and by engaging in the complex history of female subjugation by men, rooted in reproduction.

 It is time to open our eyes to the norms we accept in our hospitals regarding birth. We must open our ears to the patriarchal stories we tell each other that put fear and disgust in the birth process. Most importantly, all people, men and women, must open their arms to all the strong women who both struggle within and celebrate the experience of living in a menstruating, ovulating, pregnant, birthing, nursing, or menopausal female body. Whether it be ignored, mystified, worshipped, or objectified, it is woman’s to dwell within and create.

Hannah McCormick

Get Physical

I joined the Y about five years ago because our bathroom was so disgusting ... that is, my husband had renovated it but I am very sensitive to the leftover emotions in buildings (ok, so get out your "she's too flaky" signs), and something very bad had happened in that bathroom at some point, and I just couldn't go in it. (We moved and our new house is fine.)

Anyway, back then, I joined the Y. 

I grew up an hour from the Rockies, so all winter was skiing and all summer was hiking. As soon as I was able (too soon in fact, I was only fourteen), I was off in the mountains on my own, hiking and wandering. I am no stranger to physical fitness. When my husband and I were done with trekking through the African continent, we started a farm in Italy where I was his main builder's helper, so I not only took care of four small children and maintained the household, but I also dug in the garden, hoed the potatoes, shovelled out the chicken coop, split wood, carried water from the spring, and hauled cement.

I was no stranger to physical exercise but my years as a suburban mother in a dingy outpost in Montreal had softened me. Just imagine my joy when I discovered that the Y has a running track suspended above the gym, where no one ever goes! I could run to my heart's content, all alone, and get into the zone without having to listen to music, other people, or CNN.

Last year we had a crisis and I decided that the gym membership had to go. It was a luxury. I could easily run outside until it was too cold, and use weights in the basement, and go cross country skiing.

NOT.

By last week, I felt awful. Flabby, tired, sleepy (different from tired), crabby, bitchy (different from crabby). Disillusioned (little voice saying, you are an idiot and you don't really make any difference at all).

I decided to get my membership back. That was three days ago. I went the first day and ran four k. The next day I did a yoga class that was actually not real yoga; it was punishing in its insistence on the core (as if the human body was a nuclear reactor). Then I took a day off. Yesterday I ran again. Since I started exercising again, I keep waking up in the morning. At seven. And wondering why I feel so good. 

So, of course, the answer is that I felt good - feel good - because I was using my physical body. Yes, I would rather be in the garden producing food for my family, or splitting wood that we had just brought in from the forest. But right now that's not happening, so do need to admit that the gym is where I get my exercise (champagne problem, yes, I realize that too)....

Whether we are born naturally, by cesarean section, with or without drugs. Whether our parents loved each other, or not, or even knew each other; whether the act of conception was desired or not, we all came from a home that looked a little bit like this:






We all come from the same elements, the same language of blood and oxygen runs through our veins and arteries.We are pinned to the material world with our bodies. And they are flesh, blood, bones, and muscle. Among other things. And we need to use them, actually we need to test their limits, like a child does, we need to run so hard we get tired. We need to lift things that are too heavy, so that we have to put them down. We need to jump higher.

Ride a bicycle. Go for a walk. Do yoga. Run. Lift weights. Use your body, and your body will be happy.

The Curse of the Black Crow

I had a student a few years ago who was attending births with me, and every one of the first six births she attended ended in a c-section. The sixth time, she ran out of the room and down the hall, convinced she had somehow caused the natural birth to go sideways into the operating room.

A friend of mine was standing in the hall, a family physician with a heart of gold, and she caught my student and looked her in the eye, and told her "You do not have the curse of the black crow!" and proceeded to explain how difficult it is for a care provider to accept that their patient's journey is sometimes not what anyone has planned, and that most of the time it is not the provider's fault.

I was taking care of my sister, who was in the hospital after a difficult surgery and several setbacks which were scary for her and worrying for us. She finally made it out of the grey place and we were sitting talking to the surgeon, who apologized to my sister for the fact that things had been more difficult than expected. When my sister reassured her that she had no feelings of blame, and further that the surgeon wasn't responsible, she replied, "Oh no, but I AM responsible. The buck stops here".

But it doesn't. The attendant has a huge responsibility, indeed, to care for her patient. She needs to do everything she can to facilitate healing, or in the case of childbirth, to carefully observe nature at its task. But if she has given her 100%, she has to know that there is always that element of mystery involved. The buck does not stop with us. We do not know why one woman will have a three hour painless labor, and another one will struggle and strain for two days. Yes, we can read blogs galore about how the happy, accepting woman who is comfortable with her body and open to experience will have a quick and easy birth, and the resentful and complicated one is more likely to have a c-section. But these easy generalizations are not true.

No, we don't know why some women have easier births, or why some surgeries end in easy healing and some don't, or why some treatments work on some people and not on others.

When you really believe that the buck stops with the surgeon, then you are closing a door to the mysteries of healing and the mysteries of life.

First Do No Harm

Why do I feel I have to justify myself when I say that doctors and hospitals are damaging women and babies? I have a little bird on my shoulder that says "Oh, but you don't want to seem like you are against saving lives".

We have some fantastic tools at our disposal now in the field of medical care. We have antibiotics. We have surgery. We have anaesthetics. We have ultrasound. But these tools are being overused and mismanaged.  Women are being hurt and babies are suffering because of our indiscriminate and irresponsible use of methods and materials that should be reserved for special situations.

What are the effects on mothers who want a vaginal birth and come out of the hospital with a scarred uterus? What are the long term effects on her mothering instincts and choices? What are the long term effects of cesarean section birth on newborns? What are the long term effects of epidural medication on newborns? Artificial oxytocin?

What happens when a mother in full labor suddenly becomes quiet and calm because of the pharmaceuticals coursing through her system? How does the baby feel when that happens? Is there a correlation between epidural medication and later drug use? What happens to the part of the brain that responds to addictive substances and behaviours, when the birth process is augmented with artificial oxytocin and opiates?

What happens to a marriage when a man witnesses his wife being treated like an animal? How does that compare to the bonding that takes place when a man sees his wife in full triumphant labor and birth?

What happens to little girls who are born by cesarean section? Are they more likely to birth that way? Is there a cellular memory of the movement through the birth tunnel? What are the long term effects of cesarean section on sexuality throughout a woman's life? Is she more or less likely to be fully orgasmic later into menopause?

Is there a correlation between asthma in children and induction of labor? Is there a correlation between autism and epidurals? What health problems are we seeing that may be connected to our new way of giving birth?

The average cesarean section rate in Canada is conservatively reckoned to be about 20%; higher in some places and lower in others. One in five children are now born surgically. This is a huge scientific experiment that is not controlled, or monitored, or even admitted.

Over 90% of first time mothers in hospitals in Montreal are taking epidural medication.

In spite of recent studies that show the contrary, the majority of women carrying breech babies are delivering by cesarean section.

Forty one weeks is considered standard for induction, Bishop's Score be damned! And if a woman is over forty, she is likely to be induced at 39 weeks.

We need to get these figures down and we need to start examining the effects of our modern tools, methods and materials on the mothers and babies who place their trust in us.

Ibu Robin Lim in Montreal

Midwife or Doctor?

Watch this video of Ibu Robin Lim giving birth with a doctor in attendance, then with a midwife!

Levatrice

Six weeks after I gave birth to the second of my five sons, I was driving our ancient old station wagon back home from dropping off my father-in-law at the airport in Pisa. I was happy. We were heading home to our place in the hills above Florence, where we lived in an old stone farmhouse. My husband taught English and was mostly gone in the evenings. I took care of the little ones and tried to speak Italian.

I remember where we were on the road. I suddenly realized, and I turned to my husband, and said: "I want to be a midwife".

I volunteered with St. John's Ambulance when I was thirteen. I learned everything a young girl could about first aid, and I competed in contests, fake blood and all. I volunteered every Sunday at the Grace Hospital - maternity care, 70's style. The moms were in wards, the babies were behind glass, and the dads could watch them from the hallway. My duty was to take each dad to his proper mom, and to distribute evening snack: apple juice and tea biscuits. I loved it: I loved the new babies, the new mommies, the warm, tea biscuity smell of babies, poop, and women's bodies.

I had a butcher-shop experience at that child's birth: unable to understand the language, I turned to victim mode and suffered uncaring doctors, making jokes over my body; a midwife smoking cigarettes; general anaesthetic, and a baby I didn't even see for over 24 hours.

Midwifery seemed like a good idea.

By 1988, I had enrolled in the Apprentice Academics program. This was distance learning, the good old fashioned way. I read the texts, wrote the assignments, followed my guide, and we sent envelopes and packages back and forth acroos the Atlantic.

By 1991, we had four boys and our small mixed organic farm (complete with large stone house to rebuild - just the two of us....with a little help from our Wwoofers - but that's another story); a large garden, chickens, ducks, geese, a vineyard...life was good! But I still dreamed of midwifery and studied my textbooks at night, collected my Birth Gazettes every month from the postman. I wrote a couple of articles....kept in touch with the lovely women at the Farm.

In 1997 life changed and we ended up in Montreal. I was working as a doula and witnessed many births over the years. These were hospital births.

I am a levatrice - this is the antique Italian word for midwife. I don't use the words "midwife" or "sage-femme", because if I did, I could be accused of practising medicine without a license. But I don't practice medicine. I attend women in childbirth.

I am in the final lap of a years-long process that will end with two exams. When I pass them, I will be able to put the letters "CPM" after my name. Certified Professional Midwife.

I teach many young women about how to care for a woman when she is giving birth. These women ask me about the best path to midwifery. There is no best path. My path has been long and interesting, and I am blessed to be able to say that I do what I love.

But at the same time, I am nervous every time I go to a woman's birth. I am excited, and honored, and a little afraid, to be taking part in such a powerful event. And so, I am nervous about my exams. I want to pass, but a little voice inside says that maybe I'm not learned enough.

So, this is the card that was shown to me:

Three of Wands (R) - Learn to be receptive to your needs for a new direction - recognize when your talents, skills and efforts are being wasted. There will be resolution after some struggle - but, much work is still needed. The proper balance has not been obtained because you are preoccupied with your "inner" thoughts to the exclusion of outer advantages. You are actually looking away from the power that is available to you. You have become too giving and this allows others to take advantage of you. You need to check everything before moving ahead. A careless approach can ruin everything. You may experience the failure of some project due to "storms" or problems that are greater than you had anticipated.
You are trying to become involved with the environment after a lengthy time of detachment and reflection which has been disturbed by negative memories. You must be alert to the new opportunities that present themselves and use them wisely. Remain open and receptive to new business ventures and partnerships with reputable people. Be willing to operate from a place of integrity as you move forward - assured in your mind that your heart, mind and spirit are in balance and you are clear on how you wish to handle upcoming situations and the important choices you will be making.
There can be flaws that interfere, keeping dramatic progress on the path just out of reach. The desired qualities for this stage may be present in abundance, but for some reason, the project at hand is off target. Check, possibly right project, wrong motivation or right motivation, wrong project. Guard against over optimism and spiritual vanity as you would against pessimism. Guard against complacency as you would against a nomadic restlessness forever more and more.

I would like to send gratitude to everyone who has accompanied me along this path - and also to invite everyone to a huge party when I finally get that CPM. Maybe that's what it's all for....

Birth Companions Doula Course

The next Level One doula course is coming up soon - starting on April 15! This course will give you the skills you need to volunteer with Montreal Birth Companions.

Level One Doula Course

Looking forward to seeing you there!

MBC presents Ibu Robin

Robin Lim in Montreal!!!

Come and hear Robin Lim speak about gentle birth in Bali, Indonesia, where she runs a midwife-led maternity clinic.

For more details, click here.

Birth in Bali

Katherine Bramhall, who will be part of the workshop coming up in Bali this April, was influential - dare I say pivotal - pushy even - in my decision to go to Bali as an intern last summer.

I was honoured to be part of an amazing phenomenon that is happening in Bali and around the world. Robin Lim, or Ibu Robin, as she is known by those who have heard of her, is the mainstay of a birth house in Bali where women come from miles around to give birth to their babies. Birth at Bumi Sehat is free of charge for those who cannot pay, and the midwives that assist them care for these women with love, respect, and skill.

If you are interested in midwifery, and you would like to learn about caring for women in a new way, then this workshop is for you:

Midwifery in Bali

It will cost a lot of money - but it is so worth it! I went there for six weeks with my husband and our youngest son. I have been studying midwifery for 25 years and practising for fifteen, and I learned something big during my stay there EVERY SINGLE DAY. I did not go with too many preconceptions, but I was amazed at how much I learned there and continue to learn from Ibu Robin, from Erin Ryan, from the midwives, the bidans, the people I met, the wonderful support staff, and of course from the women I served.

I was there during a slow period, and didn't see as many births as is usual for six weeks - but my days were as full as could be.

If you have any questions about this amazing possibility, please let me know and I will be happy to open my heart to you.

One of the sweet babes born when I was there

Going to work!

Candle with flowers

Prenatal Classes starting February 18, 2013

Birth Witness

Montreal Birth Companions is an organization that serves about sixty women a year. We provide doula services for the poorest of Montreal's women - the refugees, no-status women, and very recent immigrants. We have been active in Montreal for almost ten years, without funding, and without office space. The volunteers are either trained doulas, or doula students, matched carefully with the women they serve.

We have seen our share of disrespect and abuse in the maternity care world here in Montreal, and we are now initiating a project which hopefully will be the beginning of a constructive dialogue.

We are gathering stories from women, which are about instances during their birth experiences where they felt uncomfortable or maltreated. 

We are not out to vilify obstetricians. Our goal is to help to create an environment within which a woman who will be going to the hospital to give birth can be secure that she is treated with respect, whatever her language, colour, marital status, financial level, or whether or not she has healthcare coverage.

We believe that a woman, any woman, has the right to be told what her options are; to be asked permission before she is touched; to be spoken to with respect.

We believe that the attending caregivers, whether they are doulas, midwives, nurses or physicians, have the responsibility to care wisely for their patients. This responsibility includes providing information, asking permission, and exercising cultural sensitivity. 

MBC volunteers have witnessed physicians loudly scolding women without health coverage, as their baby's head is crowning, about their financial mess. I have personally witnessed an OB who made an overtly sexual remark about a vaginal pack. I need to remind residents that it is not okay to rupture a woman's membranes without telling her, just because your hand is in her vagina. I myself pushed my agenda on a woman who was heading for what I considered to be an unnecessary cesarean section, resulting in her feeling betrayed and angry instead of happy about her birth.

We need to talk about this abuse loud and clear. We are not suggesting that every woman in Canada must have a natural birth. We are suggesting that we start to create a system where the woman is at the centre, surrounded by respectful attendants.

Justice

We used to be ridiculously politically incorrect in the olden days. Remember Flip Wilson, dressed in the judge costume, wearing a tilting greyish wig and the "Heah come da judge!" routine?

So, I had to go to court to testify about a case that involved my car and a driver who decided it would be ok to smash into me and then drive off. But two different people (me duh and someone else) got his license plate number. So I toddle down to court on the metro (subway in Montreal), on one of the freezingest cold days of the year, when I'd much rather be at home working on my book (yes, writing another one)...and anyway, the guy had paid his fine and I didn't have to go. They refunded my metro tickets and sent me home.

And I started thinking about justice and how it works.

1. Someone does something bad.
2. They get caught.
3. A group of people decide that the person did indeed do the bad thing, and how the person should be punished.
4. A negotiation starts.
5. Sometimes, justice is done. Sometimes, it isn't.

And I started thinking about the interesting projects I am involved in. I just started helping to organize Montreal's One Billion Rising event. This is a worldwide event that was conceived by Eve Ensler,  to demand an end to violence against women.

This is justice.

Montreal Birth Companions has started a Birth Abuse Witness Program, which will collect attestations from women who have been left uncomfortable with their birth experiences. These attestations are part of a campaign to change the maternity care system in Montreal.

This is justice.

Every week, MBC volunteer doulas assist women who have no resources, who are from other countries, who may not have families or partners here, who may have experienced abuse and violence. MBC doulas accompany these women to give birth and provide a safe and nurturing environment for them and their families during this important time.

This is justice.

At Bumi Sehat, in Bali, women are given quality care during their childbearing year. Midwives, doctors, acupuncturists, and others care for these women without payment because of the generosity of others and their desire to do good.

This is justice.

So, justice isn't only about hit and runs and terrible crimes. When those things happen, yes, we would like the state to get involved and do its thing. But the simple acts of justice, love and kindness balance out. They have to.

Let's find the balance.

Lovers

We went out last night to talk. There's always someone around at our house, and everyone always wants to hear what we are talking about and why. Sometimes its nice to get away, in the event that we can't find Maxwell Smart's Dome of Silence.




Our favourite quiet lounge was being renovated (?why? It was perfectly nice before...) so we drove and walked around for a while - this may sounds pleasant but I find it hard to have a conversation when you're walking together in anything below 0 degrees C. We finally found a nice little bistro, and we sat and had a drink and I made lists of our whacky pipe dreams from 2003 ahead, and we tried to decide what to do with the next five years.

We've always been dreamers and planners. From the moment we met, we were arguing about how exactly to make the world a better place. Over the past few years, we've had all sorts of ideas - from going back and living on the mountain,

to opening a bookstore/cafe in Florence, Italy, to starting up a catering business in Barbados. 

Right now, the plan is to build up the place up on the mountain and let birthing women come there to have their babies....Sounds great, no? If you're reading this and you're interested in joining us in this project, let me know.

I digress. Lastnight as we were drinking, arguing - we rowed a little close to the shore a couple of times ("I can't stand the way you always do that..."), and writing lists, I noticed a lovely young couple sitting by the window.

She was pretty. Dark hair, tied up in an abrupt pony tail. Skinny body and face. She was dressed up in tight black pants, and a little sweater and waistcoat. Not much makeup. Her hair was falling in spirals next to her face where it had rebelled against the elastic. He was handsome in a typical boy-next-door-who-hasn't-shaved-in-two-days way. Sexy. He was wearing a button down shirt, with v-neck pullover on top, jeans. You could tell they had both picked out their clothes carefully.

They were in love. She held his hand. He would her hair around his other hand. They smiled at each other and laughed.

I'm putting this message in a bottle and throwing it into cybersea:

Keep your love alive. Never forget that feeling of awe that you had when you were sitting in that Bistro. Time will try to rob you, but don't let it. When you decide to have a baby, be careful. Don't let anyone tell you what to do. Go with your heart. Only you know what you can and want to do - having a baby is like making love, it's between the two of you and no one else.

Plan to sit together, in thirty years, and make a list of crazy dreams from your past, present and future...

Trust Birth?

I read a post on the ubiquitous Facebook the other day about a triumphant birth. A woman and her husband went to the hospital with their doula. The woman laboured with the support of those around her - her doula, husband, and the medical staff. She required no drugs, no medical interventions at all. In fact, she had a natural birth in a hospital setting. Which is wonderful, joyful, and, unfortunately, increasingly rare.

Why did she have a natural birth? Was she lucky? Did she just happen to have the right combination of a good pelvis, an agreeable baby, health, happiness, strength, the right medical staff, and good timing? Or was it really because she did a prenatal class that was somehow better than any of the other prenatal classes out there? Or was she determined? Or was she a positive thinker? Or did she have some good karma coming her way?

Probably a little bit of all of the above. When I am working with a woman I feel confident about, she has a good combination of strength, flexibility, confidence, vulnerability, self-knowledge, and a touch of who-gives-a-shit. She may or may not have an amazing support system and wide hips. She may have had a terrible childhood, and she may not be a very nice person. She may be having trouble in her relationship. She may have a lousy relationship with her mother. She may be tiny. She may be fat. She might not eat too well.

But there is a certain woman power that she will have, that will come out when she is birthing, that reassures me that this woman will not be too much of a challenge during and after labor. I am confident that labor will unfold, it will be powerful and most probably painful. It may make her feel like she is going to die, but I will be able to keep her to her path.

Most doulas, midwives, and physicians can tell you that they have a sense of a woman who is heading for a natural birth, if she is given the chance. The problem with most hospital births these days is that very few women are even given that chance. The epidural rate for first time mothers in the hospitals in Montreal is over 90%. That is no chance at all, for a woman who is feeling labor for the first time.

So, as the Muslims say, pray to Allah, but tie your camel to a tree. That is, don't rely on faith to make things happen for birth. Although much of it is chance, or fate, karma, or the divine, what is left over is human intervention - or human strength - or woman power. Let it shine!

Birth Abuse

Birth Abuse. This is a commonly heard term these days in birth circles. What exactly does it mean?

Is it abuse when a woman wants to have a home birth but can't find a midwife because of government regulations, so she ends up compromising on one of the most important decisions in her life, and having her baby in a hospital, lying on her back?

Is it abuse when a woman from another country comes to the hospital in active labor and is spoken to very loudly as if she is a slow-witted child?

Is it abuse when a woman wants to give birth squatting, after a two hour labor, but the doctor insists she lay down, and after the head is born, a shoulder dystocia develops and the doctor pulls so hard on the baby's head that he breaks her collarbone?

Is it abuse when a resident has his hand in a woman's vagina, reaches for the amnihook, and before anyone can say "boo", he breaks her waters?

Is it abuse when a midwife insists that a woman lift her shirt so that she "feels more relaxed" as her baby is being born?

Is it abuse when a doula pushes a woman just a little bit too hard to avoid taking an epidural, and afterwards the woman feels she has been traumatized by the pain?

Is it abuse when a woman is pushing and the doctor stands between her legs and yells at her, demanding to be paid in cash?

Is it abuse when a doctor speaks in a sexual way to a woman who is ecstatic, just after giving birth?

I have witnessed all of these situations, and I believe they all are examples of birth abuse. Yes, some are more shocking than others. Some are definitely in the grey area. But, essentially, abuse in the birth world takes place when there is an absence of respect. Respect is paramount when a baby is being born. The woman who is doing the work of bringing a new life into the world is more deserving of respect than anyone else. But, strangely, in our world, this has been turned on its head. The birthing woman is under everyone else's thumbs, saying "yes" and being a good girl, and agreeing to other people's agendas and priorities.

Is it abuse when a woman goes to the hospital after laboring at home for many hours, and a collective decision is made that this baby needs to be born surgically? NO.

A simple procedure, or surgery, or an interventive test, do not constitute abuse. Abuse takes place when anything is done to a woman against her wishes, or without her agreement. Simple.

Birth abuse is big. Everyone who works with birthing women - doctor, nurse, midwife, doula, anyone - should take a few minutes out of each working day and have a close look at the way they have treated their clients, and if they feel they have not treated the birthing women in their care with the UTMOST respect, then they should make changes.

Birth can be powerful, it can be joyful, it can be frightening and terrible. Birthing women need to be at the centre of everyone's vision so that we can recover an essential balance that we have lost. When women are at the centre of the birthing world, who knows what miracles we will encounter?

Level One Intensive Doula Course

Intensive Level 1 Course!

 

Four Sundays – January 13, 20, 27, and February 3, 2013

Graduates from Levels One and Two are already working as doulas … if you feel you would like to accompany women through the childbearing year, take a few Sundays to spend with us learning doula skills, and more!

Level One gives you the skills to volunteer as a doula with Montreal Birth Companions, or you can go on to learn more doula skills in Level Two, which starts on February 9, 2013.

For a registration form or more info, please leave me a comment below...

Cost $400 (plus tax).

Freedom For Birth (Web version)

Upcoming Events

The Power of Love

My husband suddenly said to me the other night, "Remember when you were in labor and you asked the midwife if she thought you could birth vaginally"?
I though back to that afternoon. I was working hard at a VBAC. I was in the birth pool, and fast approaching a milestone in my labor.
"No, I don't remember that. What did she say?"
My husband looked at me. "She said, "No." Just like that. No."

"Well", I said, "that's where I learned midwifery. That's where I learned what NOT to say. That birth and many, many other births where I have been the witness of what NOT to do or say to or with a birthing woman."

Last week we went for a run together. He had a heart attack two months ago and you could not imagine a less likely person to have one ... fit, energetic, athletic, and all that ... anyway it happened, so he is slowly getting back into his exercise routine. He was wearing a heart rate monitor. I was running next to him and he couldn't get his heart beat lower than 140, unless he slowed to a walk. I ran ahead. His heart rate slowed down. I ran back to be next to him. His heart rate speeded up.

I ran a few blocks ahead of him the whole way and he kept his heart rate level. That means ... like the Kinks song - "you make my heart sing..." which is nice, after thirty years.




But it also means, as described so beautifully in the Secret Teachings of Plants, that the heart itself produces messages and hormones that we still do not understand.


And that's where the presence of a doula makes such a difference to the birthing woman. Because she understands that there are reasons for and reasons why that we cannot understand. She sees that most of the time - not all, but most - the body, mind and soul work perfectly well together - or as perfectly as we are used to, which ends up being that raggle-taggle, patched together, immensely beautiful way we call being alive. She sees that a woman who is left alone, within a bubble of her own labor, surrounded by people who love her - and this does not exclude the attending physician, if that is what she desires - will bring forth a child in her own sweet time, using whatever means we understand or do not understand.


And that is also why we have to be so careful when we are attending a birthing woman. Careful with our words, with our bodies, with our thoughts and emotions. Because who knows how sensitive she is to the slightest nuance? And who know how your own heart is acting? What are you communicating to the birthing woman under the surface of your public presence?

Breathe Together

I have had some feedback about the title of my book. Several reviewers have given it "five stars", but have had doubts about reading it because they thought it would be an angry, polemical work about the horror of hospitals and the saintliness of doulas.

And it isn't.

I have a holistic world view, which means that I believe that there is a place for most types of activities and interventions, within very strict limitations. A 90% epidural rate for first-time mothers is just plain wrong. 90% of all first time mothers do not want an epidural, although certainly some do. And very few first-time mothers actually need pain medication. If and when they do, an epidural is a very effective tool that can provide exactly what the doctor ordered.

Cesarean sections are also very, very useful tools. Surgery can save a baby's or a mother's life. But one quarter of mothers and babies in North America are not in danger of dying during childbirth, adn so we see that this tool as well is overused.

We have come to believe that the overuse of these tools is necessary. Women are afraid of pain, men are afraid of birth, and children are being born into bright lights, machines, masked humans, and a mother nowhere in sight.

Here is a little explanation of my use of the word "conspiracy":

The root of “conspiracy” comes from the Latin conspirare, from con- “together with” and -spirare “breathe.” My hope is that just as women instinctively know how to breathe through their contractions, we will realize that we all know how to breathe together. Whether we are in a hospital, a birthing center, or at home, when all of us: physicians, nurses, midwives, obstetricians, doulas, birthing women, partners and, of course, the baby, are working as one in the birthing room, then the birth experience will provide a better start for the new family. When the birthing woman and her child, and not a machine or a chart, or a schedule or an agenda, are the center of our attention, then no matter what the outcome, the new mother will feel better about her experience and will be better able to care for her child. When we simplify our approach to birth, we will see that birth is simple.

War on Women

My heart is with the women of Goma.

Rebel soldiers captured the town of Goma yesterday morning, while the UN and the world stood and watched.The country's army can do little against the rebels, and the UN soldiers do not have a mandate to strike against them, so they are now in control of the airport and much of the town, according to news from the area. They are moving towards Bukavu today.

Why do we care?

Here are some statistics from the website of the Panzi Hospital, which opened in 1999 in Bukavu, 100 km south of Goma. Dr Denis Mukwege founded the hospital, as a response to a growing number of sexual violence victims in the area. He is still the medical director, and the hospital specializes in gynecological surgery for fistula and for vaginal reconstruction following violent rape. They also provide treatment and support for women suffering the effects of these attacks.

• It is estimated that there are over 200,000 surviving rape victims living in the Democratic Republic of the Congo today.
• From 2006 to 2007, an estimated 1,100 women were raped EVERY DAY.
• Today, it is estimated that 36 women and children are raped daily.

On October 25, 2012, four gunmen attacked Mukwege's home, killing his guard. They fired bullets at Mukwege as well, who avoided them by dropping to the floor.^[2] After the assassination attempt, Mukwege fled to Brussels and the Panzi unit reported that [his] absence has had an “overwhelming effect” on daily operations at the unit.^[3]

Four women are raped every five minutes in the Democratic Republic of Congo, according to a study done in May 2011 by three researchers, including SUNY’s Tia Palermo. “These nationwide estimates of the incidence of rape are 26 times higher than the 15,000 conflict-related cases confirmed by the United Nations for the DRC in 2010,” says Palermo. The level of sexualized violence has received an intense amount of international focus, which has revealed the varied kinds of horrors soldiers have perpetrated against women, even while the country maintains the highest number of U.N. peacekeeping forces in the world. (see here)

As the fighting escalates, families are fleeing from Goma, but they have nowhere to run. There are five DP camps in the surrounding areas and these are full. Families are being separated. Pregnant women are still giving birth, and if a woman survives a gang rape there is a good chance she will have conceived and will give birth. Where are these women to birth and who will attend them?

Montreal Birth Companions doulas have accompanied women from Congo and other countries who have suffered rape and violence at the hands of "freedom fighters" who use rape and sexual coercion as part of their arsenal. These women are strong, and we are honored to accompany them as they give birth. But these are the lucky ones, who have made it to a more peaceful home. Thousands, if not millions, if not billions (One Billion Rising) of women are being raped, beaten and murdered, even as I sit in my comfortable warm living room and write these words.

Please help in any way that you can. Spread the word about this conflict. Donate money to charities that are working on the ground to assist women and children:

Pennies for Panzi is a campaign that is raising money to create a daycare where children of rape survivors can be cared for while their mothers are healing.

Heal Africa provides assistance for women and children in Congo.

Medica Mondiale "supports traumatized women and girls in war and crisis zones."

Safe World for Women is a UK based charity.

This winter season, have a party, do some dancing, and ask your guests to donate money to a worthy cause. If you are a medical professional, consider going to a war-torn country to donate your skills. If you own a company, perhaps you can make a larger donation or donate materials.


Remember how lucky you are.

Bad Science, Bad Medicine, Bad Luck

I am actually enraged this morning, and I have been since last night. It's just no good any more to pretend to be kind old Mrs Tiggy Winkle, and watch women being abused over, and over, and over again in our worn out medical system.

A few weeks ago, I witnessed a natural, speedy delivery. The woman was effectively pushing in a supported squat. Enter the doctor, who cannot catch a baby from underneath and pressures the woman to lie down. A small shoulder dystocia develops. Doc pulls on the head like there's no tomorrow and breaks the baby's collar bone.

That same week, a foreign lady let me know that an OB at the same hospital has been charging her $100 cash for each prenatal. Here in Canada, that is ILLEGAL.

She labors beautifully, and is almost delivering, when the doc suggests an episiotomy. This was the one thing, the ONE THING, that my client was terrified of. Luckily, she pushed the baby out with the next contraction.

Move forward, random thoughts: A client was in the hospital for twelve hours. During that time, she saw about ten medical professionals. What do you think the most-asked question was: How are you feeling? Nope. "Do you have any questions?" Nope. "Is there anything you need?" Nope. It was "Have you had any miscarriages or abortions. Well, it's not rocket science to figure out that that may not be the best question to ask a laboring woman for two reason: One, she may not want everyone in the room, including her partner, to know. And, Two, these are painful memories that she may not want to think about.

But yesterday takes the cake.

Lady is being induced, medically necessary induction. Gets put on the pit. She's 2 cm. Then in five hours, she's seven cm! And then two hours later, still seven cm! They are talking AROM, so my client wants me to come to the hospital. Fine.

She's laboring so well, not feeling her contractions at all. I have seen this, infrequently, but I've seen it. The doc wants to AROM, but since she's seven cm, she decides to wait it out.

Finally, in the evening, another physician comes in and checks her. She's two.

Discussion. Justification "your vagina is a funny shape". "She's a good resident so we don't check her results". Even when those results are difficult to believe? Really? Then, a peace offering. You stay here and sleep, we'll start the induction again tomorrow.

Bad Science: why the induction? check your results, and especially check a student's results. Have a look at how you're playing with the insulin and oxytocin.
Bad Bedside manner:  Is it necessary that a woman not eat for days? Is it possible to at least make eye contact with the doula, so that she doesn't feel like shit when she leaves the hospital? Are you going to apologize for your mistakes?
Bad Luck:  How often do iatrogenic errors lead to major consequences?

Where is this all leading? It's not leading to a rise in home births, at least not in Quebec. I was speaking to a midwife yesterday from another country who has witnessed over a thousand births, and she is not certified here and therefore is not practicing. There is no bridging program that effectively allows for CPMs to become certified here in Canada, so we are left with a lack of midwives and an overburdened hospital system where errors frequently can and do happen.

Comments? What are YOU doing to change obstetrical care in your community?