by MotherWit | Feb 17, 2012 | Uncategorized
I recently attended a birth with an apprentice I chose specifically for a certain couple. Why did I choose this particular student to accompany me? All I can tell you is that I had a feeling. I have many students who enjoy attending births with me, but this one lady came very strongly to mind when I envisioned who would be a good fit for this couple.
My gut feeling registered funny in my head though, because really, the student and the couple were very different personality wise. My student is very quiet, gentle, and kind of shy in a sweet way. The couple is straight up, have no qualms about dropping f-bombs, and are expressive and raunchy (all in a great way).
I also encountered a bit of an ethical conundrum. My head kept saying that I should be very careful about taking a calculated risk with my apprentice’s heart because of her own life stories. On the one hand, I knew our client’s GREAT birth experience would bring some healing and inspiration. On the other, a challenging, disappointing birth experience could potentially bring up a lot of painful and discouraging feelings. As we can never predict birth, especially one of this particular nature, it was not “low risk” for my apprentice. All I knew was that it felt really important for this student to be there. Whenever I would think of bringing on someone else whose own personal history rendered them “safer” emotionally if this birth didn’t go well, I kept thinking of this student. I outlined the situation to her, and she agreed, admitting that it could be a challenge, but that she was willing.
The couple really liked her presence, and were generous with their inclusion of her in their prenatal/birth experience. She is a quiet observer, but still waters run deep. I feel like she provided a sense of deep listening and compassionate grounding for this couple. There was something in having a commiseration about past birth experiences that I think made my clients feel secure with her. Not that my student talked about her stories in detail at all, but the general gist was something I knew the couple appreciated. When labour was getting stronger they asked when she would be there, so I was very pleased with the connection.
Sad to say, the birth, while everyone came out healthy and sound, was not even close to the experience I had hoped for either as a doula or a mentor. To make a very long story short, we all ended up witnessing (and our clients being the victim of) one of the worst abuses of medical authority I have ever seen. Of many of the things I specifically didn’t want them to have to have to bear witness to, they did, in extreme and almost unbelievable ways.
As a doula, I felt devastated for this couple. As a mentor, I felt terrible. I wanted so much to have everything be good. I didn’t feel as responsible for what happened to the couple, as things were entirely out of our control. We know as doulas that we can’t wave our magic wands, turn back time, and make the staff be nice. We can only deal gracefully and help the couple stay focused on birth rather than anger in the moment. But I certainly do feel responsible for my student, as I took a risk in asking her along, knowing it might be hard on her emotionally. Well, this birth would have been hard on ANY student emotionally, especially if were your introduction to birth attending. But I had really really wanted it to be good for her in particular.
From what I can tell, my apprentice’s presence added extra support to a difficult situation, which was great for the clients. And I think she’s doing okay. I remain available to students who need to process their experiences. Sometimes it takes a while because they are all busy with their lives as I am with mine, or sometimes it just doesn’t feel right yet, but at some point these things come up when they’re ripe and ready, and we can go over them. Sometimes it takes a while to process things before we wish to talk them out. I did feel I had to very quickly address the violence that we were exposed to.
I know this is going to sound deeply weird, but I had a dream recently in which I was on this bright, clear rocky mountain, very high up. A man dressed in dark furs leather coverings of a culture I can’t identify said to me, “This is for you,” and handed me a reddish brown stone with black stripes through it. He talked to me about how the masculine principle in birth is really important, that the practice of modern medicine (the gender of the practitioner doesn’t matter…the energy of diagnosing and applying strong interventions being “masculine”), has in many ways improved lives for families over time. It is as “inspired” as any other healing modality. But the problem is that this masculine principle often ends up being the last word, usurping more feminine, intuitive, experiential wisdom instead of supporting and working in cooperation with it. It has made things out of balance and now many are harmed. The unpredictability of birth doesn’t lend well to the sensibilities of Medicine, and there are often a lot of attempts to control the process. In order to gain control because of this trepidation towards the unknown, coercion can be used to manipulate certain situations. I was told to remember that it wasn’t out of cruelty as it would outwardly seem, but out of extreme fear and vulnerability. This dream wasn’t spoken in so many words, but this was the “message” I received loud and clear.
I had to write it down quickly after it happened to make sure I got it all, as these kinds of dreams, for those of you who dream this way know, are precious and often feel like they resonate with an incontrovertible truth that is not to be forgotten.
I had the image of the stone placed in my hand really strongly, so as soon as I could, I looked for images of it on the Internet and found it was red tiger eye. When looking at the symbolism behind this stone, I found it is used to “protect against abuses of power”. I told my husband about my dream, and bless him, he goes along with me. He found some red tiger eye and gave it to me.
I took one of my stones (Hi, my name is Lesley, and yes, I keep stones meaningful to me in my birth bag…wanna make something of it? ;p) and gave it to my apprentice the next time I saw her. I explained it was a kind of amulet to protect her from the abuses of power she may witness in birth. When we had a moment alone, I briefly explained my dream (risking being gaped at as if I were insane). I also feel (yeah, laugh away) that something in that stone, or perhaps more accurately in the energy created by the connection to it through the dreaming and the giving of it, could begin to create a subtle shift towards healing. Sometimes less words are better and a gesture from the heart says much more.
It IS a risk to the hearts of students to bring them to births that might be hard. In the end, it’s probably better that this incident happened while I was there… because it certainly won’t be the last time she sees something like that. She saw a senior doula NOT lose her shit and go postal on the staff member (as much as it might have felt good to do so in the moment). She learned how to calm herself and take measures for herself so SHE didn’t lose her shit and go postal. She learned how to shift gears fast, help clients rechannel their strong feelings to focus on love for their baby, and how to recognize the healing in subtle acts of compassion by other staff members who were also hurt by the witnessing. She learned how one is NEVER truly helpless, and that when all else seems hopeless, we have our ability to energetically broadcast peace. When we can’t make peace, we can be it. This act holds more power than you may think.
When we sign up to be doulas, we take on the role knowing we will, at some point, get hurt. Yet even upon the hurting, we come back and risk again. It is a risk to me (my credibility, perception of my sanity, etc.)to share dreams and beliefs of such a personal nature with others. Nobody likes being judged. But like our ladies who risk their hearts by opening to the unpredictability of birth, the VAST majority of the time, the reward is immeasurable, and the healing intention is accomplished by getting down dirty real.
My apprentice accepted her tiger’s eye with a genuine smile. I’m still not sure why I felt so strongly about bringing her to this birth, and maybe I’ll never know. Sometimes it’s just a mystery and we have to trust it’s all getting worked out somewhere. I get a strong sense she’s going to be just fine, though. Not because of the stone, obviously, or my kooky dream (though I hope it it helps), but because she’s a strong, resiliant woman. She seems eager to go to more births, and that’s a great thing. She’s going to be a fine doula. Love and honour, Sister.
by MotherWit | Feb 8, 2012 | Uncategorized
One of my teachers on my path of studying body/mind integration therapies had this great saying: “The more you do, the more you doo doo.” Translation: the more you mess around with techniques “just because” instead of listening to the recipient of the work, making gentle suggestions with your hands, voice, tools, or energetic intention (IF warranted), the more you interfere with the body’s impetus to self-healing. Obviously, there are times when big guns need to be called upon in our work as doulas, like hip presses and frequent positional changes, bodywork or remedies, even sometimes a little tough love. But as the intense birth energy works through the mother to open her up and bring forth her child, our job is ultimately to support, not meddle in what is normally an already pretty perfect process.
Many doulas these days introduce themselves to me or others with their catalogue of credentials, CEUs, certifications, and qualifications. The “with whoms” and “how many hours” and “advanced studies” all seem very important, and are listed in CV style on personal websites. Now there is NOTHING wrong with constant learning. I do it myself. But at some point, clients really don’t care what you studied. Their eyes will glaze over after you’ve listed the third workshop or so. They are not concerned with a piece of paper (at least the hundreds of couples I’ve worked with aren’t…rarely have I been even asked about my certifications, CEUs, advanced training, or association memberships). They want you to make them feel safe and can usually tell by meeting you if you “click” with them or not. Their feelings towards you will usually matter more than your impressive CV.
Many apprentices I work with and very new doulas I know, still years away from getting to tons of the great educational opportunities out there, are able to exude an energy of safety and calm that is palpable in the birthing room. Many a time I have seen doctors and nurses walk in and literally say, “It FEELS really good in here. I’m just going to sit down for a while.” And they do, vibing out with the doulas for a spell. While the tools we learn from more experienced birth practitioners ARE immensely valuable, these are not necessarily the keys to becoming better doulas. More knowledgeable, and more skilled, yes. But not necessarily better. For you doulas out there who maybe see all of these opportunities online to attend amazing workshops and conferences but are unable to attend due to having young children or a lack of financial wherewithal, please don’t despair. Being a doula is about a life time of learning. Until you are able to enrich your hands on skills through continuing education, if you are able to doula with presence,awareness, and most of all love, this is absolutely good enough. As far as I’m concerned, this is a grassroots, ancient, woman to woman role (a profession too, but more a role) which, if you are called from a deep place within to do, you will know very intuitively how to do it without a lot of bells and whistles. Women have been providing this support for each other from the beginning of time, so I figure the ancestral memories of how to do it are easily activated for those who feel that inexorable pull.
Often times, the more tools one has at one’s disposal, the more one is apt to want to bust them out willy nilly if one’s powers of discernment are still developing. I hear great explanations of the chosen tools/methods that are being applied to any given scenario, because it is exciting to speak of what we’ve learned…but perhaps not while the mom is busy trying to work her baby down and couldn’t possibly be paying much attention.
My rule of thumb as a doula is to take the birthing mom’s lead. It is easy to read someone’s needs during labour. For example, some are chatty, and feel more grounded when you respond with a matched energy. You can see the labour progress and watch her fade away eventually into labour land. It is fun to have a conversation, then a conversation where concentration to keep talking through the contractions is necessary, then having the conversation between contractions, then having the train of thought forgotten entirely as the mother shifts into dream time. This is not talking randomly, it is actively using words appropriately as a method of relaxation. In fact, this woman left in what we think should be silence might actually feel more frightened or abandoned. Other women, however, would be in labour for days if you kept talking, so they would require near silence and perhaps a lot of touch communication. Some want you outside the room keeping unwanted visitors out of the space (cue lock and load sound), their need for your presence as great, just more with a focus on you containing their experience instead of mingling with it. Understanding how and when to apply the tools you have is far more important than having a ton of tools and not having appropriate discernment.
When a student or another doula I may be working with comes in with a massive amount of tools in her doula bag, claps her hands together and says, “Okay, let’s get this baby out!” identifying where the squatting bars and birth balls are (before even really tuning in), I groan inwardly. It is an almost clinical approach, and I know we’ll be in for a long haul much of the time. If, in being so excited about all the stuff you know that you start engaging the labouring mother’s intellect and lecturing about why the double hip squeeze you’re doing works, or say more than a sentence about why you’re tucking a rebozo under her tummy and shaking her around, you may be impeding the labour process for that particular woman. Honestly, the mother doesn’t give a whit about why if things are really active, she just wants sweet relief and is open to ideas you think may help her if she feels scared or flagging. That’s what she hired you for, not to give her a crash course on labour support tools.
A doula should never be dependent upon her doula bag of tricks to help her during a birth. There are times you’ll have to dash from somewhere that’s not home without your stuff, and it shouldn’t worry you at all. Your most important tools are your hands, your voice, your insight, your communication skills, and ultimately, your heart. The rest is just icing on the cake.
While accumulating a lot of knowledge and tools is a great and worthy endeavour , as you never know what could potentially help a birth that is experiencing a situation where a piece of knowledge or obscure skill could become invaluable, that list of creds isn’t what makes the doula. It isn’t what you DO a lot of the time, it is who you are. What you are DO-ing may be the simplest thing ever on a physical level, such as holding a hand or wiping away post vomit tears. But the energy you exude and the quality of space you hold is paramount. If you are distracted, inappropriately chatty, digging around for this and that in your bag “just because”, flipping though your doula manuals to review procedures, shifting around and bustling, you are probably doing too much. If you sit, stand, or hold with awareness, with presence, “listening” to the environment and working with the feel (energy) of the room actively but quietly, this may some of your most effective doula-ing. And this will be confirmed to you. I recently had a lady having her third baby. She had had epidurals for her first two and wanted to have a natural birth this time. I sat in a chair by her bed. Yup, that’s what I did. The whole labour. That is what felt right. I sat and beheld, quietly synching my breathing with hers, relaxing my shoulders when I saw her raising hers, loosening my jaw when I saw hers clench. She told me afterwards she couldn’t have done it without me, and I reassured her that I did absolutely nothing, that she did all the work and was blessed to have had a nearly pain free birth. She said, “But you weren’t just sitting there. I could feel waves of absolute calm and trust coming from you. I felt your connection to me unwavering, and it made me unafraid.” Remember, labouring ladies are deeply attuned. A touch that has no heart in it will often be noticed and not appreciated. Zoning out because “there’s nothing to do” makes some feel abandoned. Keep checking in.
In the doula training I provide, we certainly go over a whole bunch of nifty tools gleaned from almost two decades on the job, but those are only stepping stones. I prefer to focus on the quality of presence a doula holds for her clients. How do you listen? How do you tune in? How do you hold the space? How do you channel calm into a stressful environment? What may you need to work on within yourself to have more access to insight and intuition? What can you broadcast energetically to bring a positive change to a situation? This is doula-ing in the deepest sense of the word “holistic”.
There is a BEAUTIFUL scene in the British series “Call the Midwife” which illustrates the essence of what I’m talking about. A clumsy new midwife named “Chummy” who has barely passed her qualifying exams experiences her first professional clinic day. An obstetrician has been called to this clinic (run by nuns) in London’s East End (circa 1950’s) to assess a case of a woman whose pelvis has been deformed by rickets. She has lost four previous babies at term due to severely obstructed labours. Now with the National Health Services, she gets the opportunity to have a Cesarean this time, and the only shot at having a live baby. The doctor is explaining the woman’s rickety pelvis to Chummy, going over all this technical stuff, looking at his x-rays, not tuned in at all to the fact that this mother is looking terrified and grieving. He is very excited about the opportunity this poverty stricken woman gets to birth by Cesarean at a hospital and is kind of carried away with the details. He’s a lovely man, he is just doing his clinical job and is not at the moment “tuned in”. Chummy very clearly is, and has her eyes on the lady the entire time. You can just feel the solid, grounded compassion she starts exuding as she keeps eye contact. The mother bursts into tears over her lost babies, apologizing for her emotional state. The doctor looks uncomfortable and sheepish about the tears. Chummy takes her hand and gets close, and weaves a web of calm and safety around her, honouring her experience and her emotions. She explains how wonderfully safe this mother is in this excellent doctor’s hands, that this is a new baby and new experience, and that everything is going to be okay. For all her lumbering ways and technical shortcomings, there is authority in her emotional presence. The doctor takes her aside and tells her that she is a WONDERFUL nurse midwife, because she has provided one of the most valuable things to her patient, which is a sense of safety and trust.
In my humble opinion, THAT type of doula skill is the most important to develop…excellent touch, verbal, and energetic communication and environment monitoring. And you don’t even have to write it on your CV!
Doctors, nurses, and midwives are often reminding themselves to “sit on their hands” to allow the birth process to unfold optimally without unnecessary intervention. Doulas must be careful of this too. Remember, we are not “Do-las”, which entails bustling around all efficiently, spouting our street creds, getting the job done with an agenda, and owning “successes”, but “Doulas”, who inform, nurture, honour,and support in the unique way each situation calls for…with presence, insight, grace, and love.
by MotherWit | Jan 7, 2012 | Uncategorized
One of the sweetest things about being a doula is seeing how much love is generated by the birth of a new baby. It doesn’t have to be the all natural picture perfect birth either. It is the parents’ connection with the baby, the connection of family and caregivers which creates a powerful vortex of love. As the new wee one lies naked upon his naked mother, quietly taking in the world from his safe harbour, a magical hush settles.
As doulas, we are often included within this inner sanctum of crazy, mushy love. I recently had the joy of spending about eight hours in a tiny little curtained cubicle of a post Cesarean recovery area with a beatific mother and father, their precious baby, and my apprentice who was witnessing it all for the first time. What was so joyful was seeing this new family love grow bigger bigger every moment, seeing them process these feelings, and seeing how with this love came such responsibility and an eagerness to meet it. Whomever kindly holds that space and supports it with any nurturing energy at all tends to get love bombed, as we most surely did. What a blessing!
It is very important for doulas to remember that this love being given so freely to you is not really because of anything you’ve done. You’ve done the human thing, which is to be caring and supportive, comforting and emotionally nurturing. You’ve done your job, and are probably, in fact, being paid for your service. I am often heaped with praise, told the experience couldn’t have been done without my presence, and am called “Auntie” in relation to the baby. I know this isn’t because I’ve done anything particularly special. It is because hormones are high and I’ve helped to facilitate their flow, encouraging the emotions associated with them to flourish. It’s not like I’ve stepped off the street and done a saintly act. I’ve just done my job to the best of my ability, and done it with great honour.
It is crucial to not let this pure, precious new-parent love inflate our egos. Smile graciously at the praise, and allow that love that’s projected onto you into your heart, nourishing your soul. See it as Transpersonal love rather than feeling you are truly an object of it. If you do, you can become too attached, as who doesn’t crave in their core to be loved and praised in such an unadulterated way? But be mindful. Take that love so generously and tenderly given, and use it properly: use it to continue stoking the fires of good birth experiences, no matter how they unfold, passing it on to the families you serve. Hold every birthing space drawing upon this love, paying it forward, the love being coloured by the beautiful energy that already exists in your own heart to make your care unique.
Enjoy this nourishing perk of the doula experience. This very high energy exchange is incredibly healthy IF you can see it for what it is and flow with it, work with it, and ground it. Don’t just hold it all in and keep it for yourself. It is not that kind of gift.
by MotherWit | Jan 1, 2012 | Uncategorized
I seriously doubt a new baby will eke its way into the world out of one of my clients within the next few hours (though anything is possible), so I thought I’d look through my birth notes of this year to see what’s cooking in terms of the efficacy of the work of doulas.
This year I attended quite a few births less than I do on average. The grand total was 37 births. My goal was to cut it down to 30, but it’s SO hard for me to say “no” to my repeat clients. I took off most of April, all of July, half of October, and only took on one birth for December. So given I was actually off call for a good 10 weeks to teach or go on vacation, it still was a decent amount of births.
I had a higher than usual amount of “out of hospital” births with midwives (six). Out of the nine planned, two transferred to the hospital in late labour for medical intervention (one a first time mom, and one a second, both for vacuum extraction after prolonged second stage), and one was risked out of her desired midwife attended birth and medically induced because of pre-eclampsia (all gave birth without epidural).
Four of my clients gave birth by Cesarean. One was planned due to a breech baby and large uterine fibroids. One was an emergency with the baby during second stage (all worked out fine in the end). One was a mom who had wanted a VBAC, but developed an infection just prior to labour, and another was a long Cervidil/Synto induction for post dates which ended up simply not progressing after a very long and heroic attempt. All moms and babies are doing just great.
Nine of my total number of 37 clients received epidurals, for all reasons ranging from personal preference (yes, doulas DO take clients who know from the get go they WILL take an epidural no matter what…we are all for informed choice) to very long, difficult labours in which the choice to take an epidural greatly helped the mom’s experience.
11 of the ladies who did not receive epidurals were first time birthers, and three out of these were medically induced (one with Cervidil, which produced a baby super fast, and 2 with Synto). One induced with castor oil at 2 weeks post dates. (Nine of these un-epiduraled births took place in a hospital setting ).
13 of the ladies who birthed without epidural were having second or third babies. One was induced simply by having her waters broken.
Out of the ladies who did receive an epidural, (one first time and one second time birther), two were long, exhausting inductions.
Two of the 37 births were VBACs (which is a low amount for my usual total). A third was an attempted VBAC, but the mom birthed by Cesarean again.
So in terms of percentages:
Cesareans: 10.8% This is less than half of our provincial average.
Epidurals: 24% In Montreal, overall epidural use is about 80% (this is not including my mothers who had Cesareans…they only took epidurals very close to their surgeries.
Because “natural” birth can mean many things, to clarify, because I work with a mainly hospital birth population, I call a “natural” birth one in which there was no epidural or Cesarean. This can include induction, episiotomy, vacuum extraction, whatever. Yes, I know, purists would take great issue with this, but if a woman is able to go into a hospital and have an induction and perhaps vaccuum extraction and can pull this off without an epidural, darn right we’ll let her claim natural birth. What are you gonna say to a lady who has a 48 hour labour and ends up with a vacuum extraction as her only intervention? Sorry, Dude, no natural birth for you? Nope. Everything is relative. I hesitate to use the term “normal” birth for all these births, though, as most births I see in hospital settings are not normal by virtue of the hoops women are asked to jump through even when they might not want to, hoops that can be antithetical to the physiological process of birth (lying on back, being tethered to an external fetal monitor, being engaged intellectually during contractions, directed during pushing, her environment outside of her control, etc.) But this does not mean women don’t have GREAT births in the hospital much of the time and are very happy with their experience, even if they were not “normal” or “natural”. So, yeah, I say natural when there’s no epidural. Period.
And the rate of moms having a natural birth:
64.9%
The most hands off birth I saw this year, meaning the baby was literally only caught once in mid-air because she insisted upon not being touched, the room was nearly silent, the mom was left to pick up her own baby instead of her thrown into her arms (the mom was on her hands and knees and the baby was scootched between her legs up to where mom could look at and take her when she was ready), the cord was left for a good 15 minutes, no perineal checks, “massage” of the uterus, or management (besides quiet, respectful vigilance)until after the placenta was born, and no routine Synto, was not where you would expect. This birth took place in a hospital with a nurse and an obstetrician who were both SO happy to serve the woman in this way. I wanted to weep with the hope of possibility.
My stats also consistently illustrate that epidurals don’t necessarily always go hand in hand with inductions, depending on the type of induction.
While many of my clients came to me wanting a natural birth, many of those who were not sure what they would choose in the moment DID end up having a natural birth. And several who KNEW they wanted a natural birth, did NOT have one for varying reasons.
The shortest labours this year were about 1.5 hours from the time contractions were noticeable. (one was a first time mom)
The longest was about 50 hours (first time mom), about 36 of those hours having contractions strong enough to make her vocalize.
The biggest baby was 10.5 pounds, born at the Maison de Naissance to a first time mom in about four or five hours of labour with a WONDERFUL, skilled midwife who knew to keep the oxytocin flowing by keeping Mom calm and focused when the shoulders proved to be quite jammed. She never screamed (PUSH, THIS IS SERIOUS!), because fear and arenaline tend to have the opposite effect on what needs to be done by the mom. It was a brilliant and enlightened approach.
Thank you, all my wonderful clients and babies, for allowing me the honour of attending your births! You are all rock stars of the highest degree. And thanks to all the caregivers who did great jobs in keeping the birthings safe and the environment pleasant. Blessings to all for a wonderful New Year!
by MotherWit | Dec 13, 2011 | Uncategorized
I was recently sent a beautiful video of how nurses process their own grief when they’ve supported families through perinatal loss. The quality of a medical caregiver’s presence can be pivotal in helping families who are dealing with grief, and my hats off to those who, with exquisite sensitivity and compassion, make a seemingly impossible path just a little smoother and more light filled. While for the most part the video was a guide to how nurses can move through their own emotions surrounding difficult experiences, it brought up important observations for me. They came up when one of the nurses was discussing her own personal experience of pregnancy from the perspective of one who sees stillbirth and tragedy on a pretty regular basis. She describes being a student in her childbirth education class, and how couples would discuss things they wanted for their birth experience. This nurse admits, “I don’t care about episiotomies or anything. I just want to be alive, and my baby to be alive.”
My heart just broke for this nurse. I witnessed someone so steeped in the experience of being a relatively frequent witness to tragedy that she dared not invest her heart in any desires towards her own birth process. It was almost as if wanting more than simple life was an audacity. I have seen this with clients who have experienced previous perinatal loss and are expecting a subsequent baby. Where once they were innocent, concerned with cloth vs disposable diapers or about the risks of epidural, or prefering to refuse a routine IV during labour, their innocence is shattered by grief and the fact that life can seem cruel. Once bitten, twice shy.
Herein lies a very important issue at the heart of some of the problems we face as consumers of medical maternity care: our doctors and nurses, given the high volume of births they see ranging from the mundane to the highest risk possible, fairly frequently witness death as a result of pregnancy and birth. It’s clearly not something they can avoid, as this is the occupation they signed up for. Remember, this exposure doesn’t mean there IS generally a lot of death as a result of birth if you look at overall outcomes. The exposure comes comes from witnessing high volumes…hundreds of births per year, many of them, depending upon the hospital centre, extremely high risk. As they say in the labour and delivery wards, most of the births are regular to the point of boring. It’s the small percentage of drama that keeps everyone on high alert. It is all part of the job of being one who assists women on this journey to motherhood. But if the experiences of trauma and loss go improperly processed, there are aspects of this frequent exposure to heartache that have can have a negative impact upon us as birthing women.
To see death in the labour and delivery ward is not the same as being in geriatrics or ICU, as many patients in those wards are expected to pass because they are old and/or sick. But when a couple is expecting a happy start to family life and that dream is tragically extinguished, not only do caregivers mourn the death of a sweet, innocent baby, but bear the burden of parents’ acute shock and grief. To witness a mother holding her lifeless baby, those months of hopes and dreams just gone, or to see a father simply shut down, his shock rendering him broken spirited, is emotional suffering I cannot even describe to you if you haven’t seen it yourself.
We are blessed in developed nations to have access to these caregivers who can save us and our babies when emergencies occur, we truly are. More tragedies than we could imagine are prevented with this incredibly skilled care. But sometimes Nature overrules and no matter what is done, no matter how many years of studying someone has undergone in surgery and pathology, no matter how much experience they have, no matter how careful they were, no matter how safe the situation might have appeared minutes before all hell broke loose, someone dies. Sometimes it can’t even be identified why. And in our culture, this is perceived unacceptable.
In order to truly understand where medical caregivers are coming from, and to glean an essential insight into one of the reasons why our birth culture may appear as wounded as it is, it’s important to look at a few thing. Take the personal grief the caregivers most likely feel in reaction to their experiences of tragedy into account (nobody goes looking for that feeling, and in fact tries to avoid it all cost). Mix it up with the weight of responsibility doctors and nurses carry for us (we go to THEM for care, expecting THEY will keep US safe). Now throw in the fact that in the midst of overwhelming grief, sometime parents might feel they need someone to blame (which will usually be the caregiver who, being the responsible expert we entrusted our lives to, “should” have been able to do SOMETHING, or something different from what was done, to avoid the devastation they are now suffering). This cocktail of pressure can potentially create a powerful fear of future emergencies, disasters waiting to happen, and ultimately, the unpredictable mysterious nature of uncontrolled, unfettered physiological birth…which, on occasion, leads to grief. And it is this fear which surrounds and permeates the hallways of the hospitals these medical professionals practice in, as well as the rooms in which many of us attempt to birth normally.
In some schools of psychological theory, it’s believed that when we experience a trauma, there is a disassociation of a portion of our presence from the experience. It is a protective function of our minds, serving to spare the psyche from unmanageable pain during a time attention is needed for survival. But at some point, that trauma and the emotions involved (that were neatly tucked away to help us function in the world) need to be revisited and processed in order for us to heal and move on, to re-associate essentially. Shamans of old believed that a piece of one’s soul actually fractured away during trauma, and got left behind in that traumatic experience, existing in a different dimension indefinitely, longing to come home. One of the ways they would seek to heal their tribes people would be to conduct a ritual of soul retrieval. The shaman would go into a state of trance, and supposedly travel in different worlds of non ordinary reality to seek those pieces of soul, bring them back to his patient, helping to reintegrate the lost piece so it felt welcome. The patient would experience a cathartic release of the emotional energy caught up in the lost piece, and then they would live a more whole and balanced life with that blessed reclamation, being able to maintain a normal instead of wounded perspective of the world.
If a person does not eventually process the disassociation that served at the time of the trauma, a person can be easily triggered into post traumatic-like reactions in situations that resemble the original trauma. Even the thought of a repeat of the traumatic occurrence can trigger rushes of adrenaline and fear. This is a very painful way to live, as access to many of one’s internal resources are limited.
All this is to say, I believe our birth culture functions around massive chunks of missing soul pieces, if you will. I make no personal accusations here, as many of the caregivers I know and love are very well integrated and can weather the occasional loss of life inevitable in childbearing without becoming traumatized. But I believe collectively, Medicine just may be learning, working, treating, and intervening from a place of post traumatic stress. And no wonder! Imagine this (and I am not making up this scenario): you’re a nurse, and you’ve just helped with the delivery of a stillborn baby who died right at that 41 week and three day line, the non-stress test you set her up for and ultrasound having seemed perfect the day before. You’re still wiping tears away after having wrapped up the little body for the parents to hold, inside wondering if you could have had any power to change this outcome if you had just a little more forcefully encouraged the mom to induce a few days earlier when you put her on the monitor. Part of you is worrying about how the parents might react if they somehow wonder the same thing, and this will haunt you for a long time. Then suddenly there are premature twins down the hall who need delivering fast to a pre-eclamptic mom and all hands are needed on deck! On the way to that family in crisis, you run into a patient you know from care you’ve given her prenatally in the hospital, who is just admitted in labour. She is wanting to birth naturally and has this list of mundane f$#*&#g requests she’s flapping in your face, requests you’ve heard a million times from a million people! You are holding so much in your heart and mind right now and this woman wants things that you might, with the perspective you’ve gained from your job, have discovered are luxuries and trivialities apart from a living baby.
I stop here to take a deep, long, breath of understanding, of compassion, and of true honour for all you are capable of and willing to do to keep us and our babies alive. I invite everyone here to do the same..take a second to breathe and put yourself in that place. Empathy is crucial to truly understanding, gratitude amplifies our loving energy far more than angry blame, and this opens our hearts to the beginnings of healing. Let us start by seeing the big picture behind what we perceive as the fear based medical practice that we feel puts our birth experiences at risk.
The average person who is effectively attempting to retrieve missing soul pieces can usually get away from their triggers to gain perspective. The woman who is constantly traumatized by an abusive partner can generally begin to heal when he is out of the picture. It takes a lot of psychological work for her to come to a place where she doesn’t perhaps perceive all other men as threats or go into shock when she sees someone wearing something he used to wear, but with support it can be done. A recovering addict must remove himself from people, places, and things for a while that he associated with using his drug of choice in order to heal. While still raw and processing his emotional pain, the associations with the drug of choice can be a powerful trigger back into addictive behaviour.
So what about the medical care giver who, after having experienced the trauma of a baby dying on their watch, has to go back into the trenches and keep going, knowing they will inevitably see tragedy again at any random time? Well, chances are they’re going to up their game in the vigilance department. And given that they’re pretty vigilant to begin with, this is saying a lot. If they’ve seen uterine rupture during an attempted VBAC, VBACs may be something they’re deeply reluctant to do in the future, for a while anyway, until the event is sufficiently behind them and they feel open to trying again. If they tried a breech birth and the baby died, chances are, they’re going to be unwilling to revisit that scenario again any time soon and prefer to perform Cesareans on their patients with breech babies. Because of a seemingly large infant, many caregivers will not be willing to allow a vaginal birth given the higher risk of shoulder dystocia and the devastation that can potentially entail. Why? Because they’ve seen it! It’s normal human behaviour. If your house gets broken into, you’ll probably get a better lock or alarm system and never leave that one window open again at night, regardless of the lovely breeze that used to come through. If you’ve been mugged, you’re going to be on higher alert when you’re walking down the street alone at night, or skip that route altogether, even though you may have walked it happily and safely every night for ten years. It is human to try to avoid pain and recurrence of trauma, and a health care provider is psychologically no different. In fact, it’s deeper than that, as they are not trying to spare their feelings necessarily, but someone else’s. They are also at the mercy of many rules, no matter what their personal beliefs, rules created by that collective deep seated fear of unpredictable old birth and death.
The build up of post traumatic stress in Medicine doesn’t help birthing families in many aspects. One could argue that aggressively applied obstetric care has reduced death all around, and sure, there are truths to that, such as the fact that experience gained in dealing with trauma provides practice with how to work with complications more effectively. I’d sure like the guy dealing with my stuck baby to have oodles of experience in doing so. But consider how fear-based care may not be so great for us. For example, in North America the Cesarean rate has risen crazily in the last decade or so, while outcomes have not really changed in response to this impetus to get babies out surgically. This is testament to the fact that women and babies aren’t actually generating any more emergencies than before, but that Medicine is scared. Scared of messing up, scared of allowing the unknown to emerge, and scared of not pulling out all the stops to get a baby out in decent shape. Women are scared too, as seen in some North American hospitals where more Cesareans are planned and preferred over vaginal birth. As a result of fear begetting fear begetting fear begetting even more fear, we have become a bundle of simmering panic threatening to erupt.
The belief of health care providers and many parents that technology and medications are always being logically and judiciously applied, or the fact that arcane practices are being imposed upon birthing women routinely regardless of their good health or what they may want, (lithotomy, continual fetal monitoring, etc) illustrates that we as a culture are servants of Terror when it comes to normal birth. We say it’s all about safety for Mom and Baby, that the hyper-vigilant, agressive “just in case” approach is for the best. But our North American statistics don’t always prove the safety of our methods of trauma prevention the way we may hope. Yes, overall we do a great job! But we can do better. When we compare our maternal/newborn outcome statistics with those of some other developed nations in which there is generally a lot less fear surrounding the birth process, a different story emerges. In these countries, trained, skilled midwives are attending the majority of normal births in birthing centres or at home, and obstetricians are usually reserved for complicated pregnancies and births. We see that they are enjoying better and happier outcomes. Our fear centred, overly managed practices are not serving mothers and babies as well as the mother/baby/wholistically centred practices they have in Holland and Norway. A mother’s positive experience of birth and postpartum is very important to these cultures. In Holland, a woman whose role is similar to that of a postpartum doula comes to the mom’s house daily to tend to her for weeks after she’s given birth. And this is at no cost to the family, the government pays for it. Our focus is single minded in that a live baby/live mother is all that’s really important; well-being is simply icing on the cake, which is an attitude very harmful to women in general.
I in no way want it to be thought that I don’t believe we should have OBs deal with normal births anymore. I will address this more in Part 2, but I want it out there for the record.
Normal, physiological birth has come to be considered a radical act in many circles. Many caregivers AND many women HOLD NORMAL BIRTH IN CONTEMPT, even though many have never even seen what that looks like. The fact that birth is SO out of balance, meaning that regular old labour and birth is rarely seen in modern hospitals, reflects a physical manifestation of massive collective terror. Aspects of that are profoundly unhealthy to women, their partners, and babies; physically, emotionally, and spiritually. Surrounding this truth are some groups of people who are yelling that natural birth is the ONLY way and that medical care providers are essentially butchering and assaulting most women in their care. This is unfair and it doesn’t help! There is so much fighting and hatred and gnashing of teeth in the name of change that small, easy steps to heal aren’t actually being taken as much as pot shots. I have heard midwives called “witches” by doctors, doctors called “butchers” by midwives, and women called “irresponsible” by anyone who feels threatened (essentially frightened)by their desire to birth on their terms. It feels very heavy, almost desperate, and sometimes I lay my head in my hands with sorrow and don’t quite know what to do. We have to move through this in a way that makes everyone, birthers and caregivers alike, feel as safe as possible, leaving us all with feelings of integrity.
If how we make choices about birth and how we react to birth is a reflection of our reverence for this mysterious energy that is Nature’s design for bringing forth life, we are in trouble. I am being asked more and more to hold support groups for women who feel deeply disturbed by their birth experiences at the hands of well meaning, but disconnected caregivers who seemed terrified of letting them do what they wanted, like birth on their hands and knees or not take pain medication. And if our culture’s disassociated, fear-triggered approach to birthing can be seen as a metaphor for the “as above, so below” principle I’d have to say I think Birth is demanding her soul back.
The divide that exists between medical caregivers and consumers who want normal births is this: we birthing customers usually don’t see babies die in our every day lives. Our perspective of birth comes from somewhere..well, more normal. Most people don’t see volumes and volumes of babies born and witness worst case scenarios, or even the occasional time a normal birth simply ends badly for no foreseeable reason. We are aware that it happens, and we are scared of it happening to us, but it’s still all just concept. We are not usually coming to hospitals triggered by tragic experiences of birth loss. Though we are not ignorant (we know bad stuff happens), we do come to birth with a certain innocence. And I think this is okay. It doesn’t help us to be armed with terror. Terror interferes with that important oxytocin flow. We come to birth with dreams. Here is where we get to the crux of the matter: regardless of what caregivers have experienced of trauma, resulting in personal wishes and/or sets of hospital rules prescribed to over manage our potentially trauma-filled births, as compassionate as we may feel for the place they’re coming from, we still want the right to dream of our good births. And we want to have our good normal births encouraged. Not just in word, but in deed. We want those dreams to flourish without “being put in our place” by the fear projections of the sadly wisened. We do not want our wishes of empowerment and joy to be trivialized by those who have seen it all and would prefer us to not have high expectations for fear of “being disappointed”. We want partners in our intent to have whole, happy births, and only saviours if that becomes necessary.
It is somewhere here, between fear and dreams, where something must give and release the pent up emotional energy we’re held hostage by and a new way, one rich in safety AND meaning, can emerge. We emphatically DO have the power and the resources to accomplish this. Real healing is essential…and entirely possible.
Stay tuned for part two: How Do We Have Our Cake and Eat it Too?: Retrieving Birth’s Soul
