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.




Wednesday, July 30, 2014

MBC Doula School


I have been the director of Montreal Birth Companions for over ten years now. We are at a very exciting point in our life as an organization, and I compare it to that time in a child's life when he (I have only sons so forgive the gender specific pronoun) leaves home to find his way. Our organization is now becoming mature and I will have to relinquish some of my hold on it and let it become what it needs to become.
So  now I have a new baby, and that is the MBC Doula School. I have been teaching doulas since 2003 and I want to expand my (and my students') horizons, and to that end I have created a school which is based partly on my basic courses (Levels One and Two), but also is based upon guest teachers who come to MBC Doula School to share their knowledge.
I have been working hard to bring this program to reality and things are coming together nicely now. I have invited several wonderful guests to lead us on our learning path and I have had lots of enthusiastic feedback from prospective students. To those of you who are far away, I am working on a web-based program that will retain the friendliness and community of our in-house classes.
Dedicated Birth Keeper taking notes @3am
The cost of the program will be based on credit hours (details to come) and, as always, I am happy to offer scholarships and internships to those who cannot pay. Please do not let your calling to this field be hindered by your cash problems!  
Remember, this program values self-directed study and practical work. I also believe that what we do teaches as much as what we say, so we at MBC Doula School are very respectful of the boundaries and limitations our students may have.
Practical work is fully integrated into the program, as an observer, a volunteer doula, shadow, or as an apprentice or mentor.

Doula Care Level One is starting on September 8, 2014. A Safe Passage will be taking place September 21 and 22, 2014. Singing Birth workshop will be coming to Montreal in March, 2015. For more information, please visit MBC Doula School
Here are the courses:
Doula Care Level I
Anatomy and Physiology for the childbearing year
Doula Care I.
Breastfeeding I.
Nutrition
Practical Component   
Doula Care Level II 
Doula Care II.
Reviewing Medical Interventions
Diagnostics
Practical Component                                                            
Introduction to Healing During the Childbearing Year  (Level III)
Challenges During the Childbearing Year: An Overview
Overview of Healing Modalities                                                   
Electives                                                                   
  1. A Safe Passage workshop                                                    
  2. Working with Families                                                            
  3. Language and Birth                                                             
  4. Informatics for Birth Workers                                               
  5. Singing Birth                                                                            
  6. Postpartum Intensive                                                              
  7. Healing during Pregnancy, Labor and Birth                          
  8. Healing during the Postpartum Period                                   
  9. Cranio-Sacral During Pregnancy and for newborns
  10. Yoga pre-and postpartum
  11. The Placenta  and Placental Encapsulation
  12. Herbalism
  13. Ribozo
  14. Homeopathy for doulas
  15. Massage: Prenatal, During Labor, Postpartum
  16. The Doula Business
  17. Birth Narrative
  18. Working with marginalized populations
  19. Childbirth Education Course (observe)  
  20. Winter Birth Retreat with Debra and Rivka                             

Tuesday, July 22, 2014

My favorite birth books


I have always loved to read and study and write. I have been asked to provide reading lists for my doula courses and I always tell my students just to read everything on paper, online, about birth, women, and healing, and to think and discuss.



This is actually the kind of advice that is too wide and vague to be of much use, so I am trying to pin down my reading list and make some better suggestions. I have created a list here for the MBC Doula School students. It's on Goodreads, so you can make suggestions and add your comments and reviews.
I hope you enjoy the list, and I am looking forward to hearing suggestions, critiques and reviews.

Happy reading!

Friday, July 11, 2014

MBC Doula School Level One

Interested in doula training in Montreal? MBC Doula School provides a comprehensive doula training with hands-on experience throughout, as the students volunteer with Montreal Birth Companions (visit us here).
Level one is starting September 8, 2014. Follow the link below to find out more about a future in birth work!

Thursday, May 29, 2014

Burnout

Mama and son in Barbados
 Mama was happy.

This story is about burnout. About that feeling you have when you have so many worries and brightly colored post-its stuck inside your head that you mainly just walk around your house looking at things.

My particular form of burnout started in December, when my mother came to visit with a large parasite on her neck. Cancer is weird that way. This thing just grew and grew and grew until it just sucked her away.

I made her a party for New Year's:

L'Chaim! 

Then I got back to work. In January, I organized a big doula workshop with my friend Debra Pascali-Bonaro. It was wonderful, all things doula, all the doula students ... the hotel was crap, I learned my lesson about cheap hotels. The food was great - having a chef for a son is a bonus (yes, I paid him). 

I also attended five births that month. I realized during some of those experiences that I had to stop attending hospital births for a while. I couldn't bear to see unnecessary things done to women by people who had not bothered to educate themselves about the birth process. 

I studied like crazy for my CPM written exam. When my second son (the boy in the picture!) was born 28 years ago, I realized I wanted to become a midwife. Not because I had a wonderful birth experience but because in fact I was horrified by the approach and the touch of my birth attendants, and I was drawn to treating women with love.

I wrote my exam, and I passed!!! Now I am a Certified Professional Midwife. 

Then the parasite on my mother's neck took over my life, from February until March when she finally passed away, I was caring for her, sometimes from a distance, sometimes right by her side.

Home death isn't all its cracked up to be. Death can be pretty awful, really. I've seen death and its never so nice, but my mother's death was hard. 

And so to mourning and grief. In the Jewish faith, you just sit for a week and don't do anything. This is good. Then for another three weeks your activities are limited. This is also good. 

I have taken good care of myself over the past month. I realized that some of my big disappointments over the past few months are really little - the rejection slips piled up, so? So I started running again, back up to 4 k, and working on it. I want to get to ten by the end of the summer. I eat well. I try to do fun things. I cherish my kids and my family. 

What is the cure for burnout? Be gentle on yourself! This means being able to walk around the house and look at things. To stand in the middle of a room and think for a few minutes. To have a piece of chocolate. 

It also means saying no when you need to. Not always, but when you need to. It means making sure you have a couple of friends you can call when the going gets tough. It means not taking yourself too seriously. It means pushing yourself to get some exercise. It means starting slowly to get yourself back at work and play, but starting! Start off slowly if you need to, but you will need to. Burn-out can't last for too long, because then it becomes chronic tiredness and pain or illness. Treat yourself like a pussy cat for as long as you can, but when its time to get moving again, you will know it.

This particular pussy cat is so happy to be back from the edge! My energy is solid and growing. I am back in the birthing room, after some time away. I have my patience back. I am looking forward to an active and productive year, as the MBC Doula School blooms and MBC continues to provide service for those who are in need. 

Thank you for traveling with me for these past difficult months - the list is long, you know who you are. 

Wednesday, May 21, 2014

Back to Birthing!



I found this beautiful broken robin's egg shell the other day. It reminded me again of how I miss going to births. I finally feel ready to go back to attending birthing women after having taken a couple of months off to attend my mother's death and to then mourn her passing.



When I had a farm, back in the days when I had four little boys under my feet; an acre of vineyard; a huge market garden and a wheat field ... not to mention needy Wwoofers and occasional building tasks (like hoisting chestnut beams for the roof) ... I digress ... when I had the farm, I used to pick coltsfoot flowers in February to make syrup for the next winter's coughs. Just last week, I found some coltsfoot on an abandoned lot in Halifax.



Spring is lovely. I am so happy that the sun has returned - I thought it never would. The darkness of winter 2013/14 was very, very dark, and I am grateful to be alive on this warm lively day.

Projects coming up: I am available for prenatal classes and to attend births; the new MBC Doula School  is growing and expanding; Montreal Birth Companions, as always, is providing doula services for women in need. 

Please contact me if you are interested in joining in any of these projects. I am always happy to share the love!


Thursday, March 27, 2014

Life and Death: A Tribute to My Mother


Death brings into question all of your life. My dreams, my goals, my aspirations, seem so small when I remember what my mother was whispering about on her death bed. 

I've always felt that my task on this earth is to try to do good; to try to be kind; to try to make the world a better place.

God knows I've failed,  spectacularly at times. I have a temper, and I "shoot from the hip", and I have a devil-may-care attitude that upsets people. I seem stand-offish and arrogant to those who don't know how deeply shy I am. But, yes, I must admit, my ability to dance to the beat of a different drum has kept me alive, literally, in the past, and probably will continue to offend people in the future.

I first met my mother after I stubbornly refused to turn from breech and the obstetrician recognized that because of a short cord, a normal delivery would be dangerous for me. My mother had a cesarean, which back in those days meant a serious incision - no pretending that cesarean section wasn't major surgery back in the fifties. It gave you a scar to remember! 

Two years later, she gave birth to my sister, and then another sister after that. Back in Uganda at that time repeat cesareans were NOT the order of the day, so my two sisters were born naturally.

My mother was a very sociable person. She was intensely creative and loved to see the world. She loved a party. She loved to talk to people. Her deafness was a real challenge to her, as she was a great and witty conversationalist. Two days before she died, my sisters both happened to be wearing pyjamas with polka dots on them. We were at her side constantly for the last five days of her life. That morning, she brightened up, looked at my sisters (both in their fifties and a little tired after having been up for three days) and said: "I could spot you girls a mile off!".

She wins the end-of-life, in deep pain, absolute pun prize.

She was always excited about my projects, no matter how zany they were. 

She was brave. She left England in 1952 with my father to go to Uganda where she taught mathematics at Makerere University. In 1959 they decided to move to Calgary where she lived a very different life and was appalled by the backwardness and provincialism of the people there.

In her late thirties, with three daughters, one of whom was spinning out of control (yours truly), she decided to move from mathematics into art and she decided to take art classes. She worked very hard and created some absolutely beautiful works. She became an artist during this time, and continued to paint, draw and create up until very recently.





These are some works she did during and just after my father died. 

Never to stay still for longer than a few years, my parents moved to Botswana in the late seventies where my mother created a silkscreen workshop that is still thriving, at a village museum:

My mother loved the desert. They would get in the truck and drive on to the pans and sleep under the stars. She loved the light.


My mother loved dressing up. She would mix colors magnificently, and she always made sure her hair was done. She loved jewelry, and perfume, and high-heeled shoes. She loved going out with me to buy a pretty dress.

She loved a party. She was always ready to celebrate! On her 80th birthday, she was with us in Italy and we drove to our favorite picnic spot: 

It is a spot by the side of the road where we stop and eat supper and watch the sun go down into the sea. We didn't have a fancy picnic basket - just the usual - home made bread, tins of tuna, mozzarella, capers, beer, ... and then we stuck a lighter into a plastic plate of cookies and sang Happy Birthday.
After the sun went down we drove to the nearby town, walked on the boardwalk, and had a coffee. A perfect party!




She loved to knit and sew. With three daughters, she always had us dressed in matching dresses, at least until her oldest decided to wear only jeans, hiking boots and a small T-shirt.

She was a very skilled textile artist: This is the front of a sweater she knitted for me from a silk/cotton mix.



She loved music. She loved art. She was always enthusiastic about going to the Musee des Beaux Arts when she visited Montreal.

She loved to get presents. 


She loved Italy. I moved there in 1985 and she visited whenever she could, which wasn't often in the beginning as she was living in Botswana. But a few years later, my parents bought a medieval tower in the middle of Umbria. It was, simply, a tower. No electricity, bathroom, kitchen, or much of anything. It had water. And it was in the middle of an Italian village.


They didn't live there, because they were still enjoying the Kalahari. So we moved in: two adults, two young children and pretty soon two more babies on the way. I don't know many kids who lived in a medieval tower for some of their childhood, but mine did - I suppose I must have inherited some of my mother's sense of adventure! 

Just over a year ago, after my father died, my mother found out she was ill. She decided to forgo exploration and treatment and instead booked herself on an art tour to Italy: 






This year, my mother spent the winter vacation with us, and she partied with her six grandsons well into the night on New Year's, 2014.


L'Chaim!!

In loving memory of my mother who died on March 17, 2014. 

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