by MotherWit | Jan 31, 2010 | Uncategorized
1) Do you NOT find it flummoxing when you know a woman will deny herself no more than one lousy decaf every day whilst pregnant? That she will let nary a piece of delicious, fresh sushi roll pass her lips for fear of making herself and her baby ill? How about wine? Not a drop after the first trimester, “just in case”. Let’s not forget unpasteurized cheese. Evil stuff. In some places, offering peanut butter will get an eyebrow raised at you, as if you have just offered to create an allergic child who will need an epi pen for the rest of his life.
Yet this same woman, when in labour, will go to the hospital with the advice of her friends ringing in her ears, “Girlfriend, you GET that epidural as soon as you feel any pain..it’s your right not to suffer!” And she will have no compunction about getting jacked up on all kinds of narcotics and synthetic hormones and procedures that have KNOWN, IMMEDIATE and possibly LONG TERM effects! At what point does this disconnect happen?
2)Women are tough. We are built to be able to weather the trials of reasonably normal labour, even long, hard labour (to a point, obviously). Is it not a physiological reality that endorphin release during labour makes a woman sleepy looking and internally focused, often quite out of it during labour? And that when the fetal ejection reflex hits and the baby sets off all the right “push” alarms, a woman will expel her baby even if she’s been up all night or even 2? Seems to me, there is quite a rush of adrenaline that takes over in normal labour, making a mom capable of pushing out her baby even if tired. If there is no evidence of true maternal exhaustion, why interfere? This should be common knowledge to those who care for labouring women, being up on physiology and all. So why is it the second a woman expresses being tired a nurse will say, “I know dear, and we don’t know how long this is going to take. You are going to need your energy to push out your baby. At least an epidural will help you get the rest you need to push out your baby properly. You want to have enough energy to care for your baby, don’t you?” So introducing narcotics and probably synthetic hormones will mean the “energy” spared is this great commodity worth all the risks? This is treating women like fragile beings incapable of managing their own experience. Besides, even if a woman is sleeping during an epidural, the quality of rest is sketchy, because her uterus is still working hard to get that baby down while she is checked out of the process. Her baby is still working, probably harder and longer in most cases, to navigate the muscles and passageways whose tone is affected by these things in Mom’s system.
Again, just to qualify, this is NOT referring to mothers for whom pain relief and hormones are a necessity to help a truly dysfunctional labour. In these cases, the benefits of these interventions probably outweigh the risks and we lovingly support the mother for these choices. In fact, they can help reboot a labour and actually make things more efficient. I’m talking about intervening in normal, straightforward birth.
3)I was asked by an older, male doctor how many babies I had myself given birth to. He wanted to know this, because he felt it made me qualified to help his patient “deliver”. I stared at him in disbelief, and again, he asked me, “How many babies have you given birth to? Are you qualified?” I snapped to and replied, “Yes…how about you?” I wonder how many babies HE’s pushed out to make himself so qualified?
4)A friend of mine was the doula at a birth. A lactation consultant was in the room, taking notes on the birth. After the baby was born, at a certain point, she “initiated” breastfeeding. All kinds of information was thrown at this oxytocin/endorphine filled mother, and the baby handled and manipulated in attempts at getting a perfect position and latch. How “successful” do you think this baby was at nursing for the first few days? Try initiating breastfeeding with a mother lamb or cat. Watch how well things go.
5)Baby does not know the thing flopping randomly in front of his face is his hand. Chances are, he’s not, in his wily little baby way, manipulating you into holding him all the time with his cries. My children all co-slept with no real restrictions. Trust me, my 11, 15, and nearly 18 year old are in no way interested in creeping back in. They do get out of there eventually, no worse for wear. In fact, they are fabulous sleepers now, comfortable anywhere they lay their heads. I am actually very happy my sweet 4 year old still likes to come into bed in the mornings, and sometimes at night too, for a snuggle. It makes the start of the day sweet.
Just some thoughts for the day.
Have a lovely Sunday.
by MotherWit | Jan 30, 2010 | Uncategorized
Wow! I am just gobsmacked by all the super positive feedback I’ve been receiving about my posts. I really appreciate all of you who have taken the time to comment, share your stories, and ask me questions.
My intention to blog was to put feelers out there to see what kinds of subjects would spark some discussions or move people’s hearts. As I’ve mentioned, I am actively writing my book Choosing Wisely: A Doula’s Guide to a Happy Birth Day. People have been encouraging me to do this for years, and now that blogging has become habit (and a very happy one, indeed), so has chapter writing. Blogging has helped me identify what tone to use, and what makes women respond. I have spent many years gathering information, knowledge, and experience around birth. My doula work is my form of activism. Writing is my tool to express what I’ve learned. I have chosen to submerge myself fully into the field of the nitty gritty work of the doula (I just had a lady say while I was leaving her home after our postpartum visit, “oh, Lesley, by the way…thanks for spending all that time cleaning my poo off the bed”…cleaning poo being an act of love too). I’ve observed and helped with the pain and ecstasy of the experience, witnessing the very best and the very worst of what birth attendants and hospitals have to offer for women and babies. I have become full to bursting with stories and ideas.
It has taken me a long time to sit with stuff, developing discernment and good judgement about what to keep and what to let go of, and am finally discovering the right words to bring to the people for teaching, growing, and healing. Word Medicine is a powerful tool, and finding the right voice to communicate with is essential. I’m a Virgo, my planet being Mercury, which means, if you put any credence into it, I gravitate towards service and communication. I’ve always wanted to write about my doula work, but didn’t want to do so yet only after a couple years of practice, or without a clear vision of what I’m doing and where I’m going with my work. My path and my vision become clearer as I go along, and I hope that clarity creates a strength to my voice. I’m the type who didn’t even think about teaching doula work until I had been practising for nearly 10 years. I didn’t want to write a book that was a rehash of the many great and wise voices already out there. I wanted to have something to contribute, based on things I had SEEN and DONE, not just on what I had studied. I think now I’ve seen and done a fair bit, and feel okay about putting it out there.
All of your feedback makes me feel a little more secure about putting myself out there. Part of me is always worried someone is going to say, “You windbag! Who are you to talk about this stuff? What do you know?” But as time goes by, I see that I am a windbag, it is true. I AM nobody to talk about this stuff, and the more I learn the more I know I don’t know nothin’. So why the hell not take the plunge and write anyway? May as well. There is room for my voice, as there is for everyone’s.
Have a wonderful weekend, and thank you, thank you, thank you.
by MotherWit | Jan 29, 2010 | Uncategorized
…who cares much about the number of centimetres a woman is at? It is a guide, like timing contractions, but in no way the be all and end all of diagnostic tools in most cases. I am irate when I’m at a hospital and a woman won’t be “admitted” because her cervix is 2cm and she’s behaving as if in active labour. So we spend the next hour or two in triage, around a zillion other couples staring at this woman who’s clearly “not coping well”, sucking up projected scorn from an eye rolling staff who thinks she’s just being a wimp and that this labour will probably go on forever, giggling about how she says she doesn’t want an epidural now but will succumb to the flock any time now, until she is rushed into her private room “surprisingly” fully dilated, everyone exclaiming how fast she went. I can’t tell you how many times I’ve seen someone go through this. She is not allowed the dignity of privacy, because her cervix isn’t matching an expectation, this privacy being something to help her labour more comfortably. I understand hospitals don’t want to admit women who are not in established labour, and that way too many women come in too early and clog up the hospital, so they get stricter about admitting. But just OBSERVE the woman! If she’s maybe making some good noises (or focused intensely on breathing), is not chatty and worried much about social niceties, looking like she’s wanting to be undisturbed during contractions and bothered very little in between, and seeming deeply internally focused, maybe, just maybe, she’s ACTUALLY in active labour, whether her cervix is behaving numerically or not. And if she’s been at home for a really long time doing that work intensively, and at the hospital her cervix doesn’t open more after awhile, maybe she SHOULD be there, just to have her baby checked on periodically, and in a private room to help her cope with an obviously challenging labour more comfortably. Compassion and dignity go a long way in potentially preventing more “stalling”.
I refuse to buy into the hype that a cervix HAS to be a certain amount of centimetres open before a woman is considered in active labour or not. I have even had experienced caregivers say, “A woman is never in active labour until she is 4cm.” Often, but not always! I have seen women who are less than 2cm in howling active labour, yes, first time mothers, and they birth within a couple of hours. Conversely, I have seen women at 9cm NOT in active labour, I swear. It’s not a common occurrence, but it happens. I’ve had a couple ladies come into the hospital at 9cm, feeling great, not looking like they’re even working hard, and then they seem to have a labour that looks like it gets progressively stronger, longer, and harder, until they deliver 12 hours later. It just happened they had very open cervixes, but the uterus needed to catch up in order to make its expulsive efforts. Of course, they were told all kinds of things were terribly wrong and that labour was dysfunctional yada yada yada, but can’t there be circumstances in which a woman’s labour is unusual, but in fact normal for her considering she and her baby are fine? I’m not saying a woman shouldn’t be observed and their babies listened to and thoroughly checked out when things aren’t within the usual range of normal, but she shouldn’t necessarily be pathologized either. Hitting a lady with those kinds of words is bound to have a negative effect upon her labour.
The effect of Friedman’s Curve superimposed upon a healthy labour does just as much to unnecessarily pathologize it by its very expectations as it does determine a real problem. Perhaps even more so. There have been times I’ve wanted to shout, “Phooey on YOU, Friedman…and your little curve, too!” But why blame him? He just did a study. It’s the people who run into the labour room with the curve on a sheet of paper, poking at it and telling the mom while she’s trying to contract in peace, “See? You are HERE! And this is how far you have to go!” which aggravate their patients to no end. I suppose it’s their way of trying to provide a container of security by helping a mother know a timeline, which, admittedly as a culture, we are obsessed with. But really, what it serves more to do is create a strong want for drugs when things rarely fit into this time line. As we all know, these have their own risks and repercussions, and usually contribute further to complications, whether obviously or subtly.
I am absolutely blown away by the audacity of some primary caregivers who announce to a woman who hits 4cm that she will go now on average 1cm per hour until she gives birth. This is just the wrong thing to say. If a woman is at 4 and looking like she’s way farther along than the beginning of active labour, it might actually be a lot faster than that. I commonly see awesomely contracting first time moms go from 4 to 10 in less than 30 minutes.Telling her she still has 6 hours to go in that state is a sure fire recipe for an epidural request. A mother who is chatting happily and having really mild and far apart contractions might get her hopes up if she’s told this information, only to be really discouraged 12 hours later when she’s around 5cm and things are just starting to get challenging. Of course she’ll doubt herself and think she needs pain relief. Also, this mom is probably going to be told she’s not progressing properly and might end up in surgery unless “something” is done.
How would the practice of obstetrics change if only a woman were told, “you are doing just great where you’re at” and were provided support instead of projected expectations upon something that’s about as predictable as a hurricane?
If most birthing women only realized how this numerical expectation contributed to their intervention roller coaster ride and their feelings of subsequent failure that their body didn’t work properly, we would create a different birth culture. If only we could harness the magnificent power of Medicine and be able to apply it in ways that didn’t routinely harm birth, it would be a different world, indeed. If I had a dollar for every woman who is told “your labour is dysfunctional and your baby is in potential danger,” I would be rich. I find myself in tears thinking about the amount of women who think their bodies failed them when in most cases, this was the farthest thing from the truth and they are berating the wrong party. While Medicine most certainly saves babies’ and mothers’ lives, and we ARE supremely grateful for those skills and the compassionate way they are usually used, it is frustratingly also the very same system who takes a perfectly beautiful, sacred, process that works well most of the time, and f***s it right up.
We don’t measure rose buds with our fingers, pinning down an estimated time of blooming. We wait and trust we will eventually see them flower. Given enough time, space, love, and nourishment, most women will birth. Sure, be vigilant. But don’t be frightening, making a woman feel like she’s stupid and endangering her child for continuing a labour because her cervix is unfurling in its own gentle time, in its own wise way, not caring a whit about a curve.
Now this is not to say vaginal exams are never important. They have their place and appropriate usage, just like any other tool. But it is, and make no mistake about it, an intervention. It is surprising to many people to know that many midwives do NOT use this as a routine tool. There are those, bless them, who trust the woman’s spontaneous progress, and that she will know when it’s time to push her baby out without filling her mind up with images of swollen and damaged cervixes because she is uncontrollably bearing down without having intellectual information about whether or not she’s “fully” dilated. Do you know how many women still believe they need a doctor to check inside them to tell them whether or not they have the right to push their babies out?! And others are filled with threats and fear about damaging themselves if they don’t stop pushing, even if they couldn’t if their lives depended on it? I have first hand experience with not having had vaginal exams in my normal births, having had a midwife who, though she would absolutely have intervened appropriately if she needed to, trusted me enough to give me the space to own my own birth and catch my own baby.
In some ways, we are still in the Dark Ages. With all our advanced knowledge and gizmos and life saving technology, we are still in our culture pig ignorant about birth and how to effectively hold it to create the best birthing outcomes. The evidence of that is in our bad birth result stats when compared to other more birth enlightened nations, and a country full of traumatized, wounded mothers, fathers, and babies. We need to do better.
by MotherWit | Jan 29, 2010 | Uncategorized
One of my pet peeves is the fact that the most widely used tool parents-to-be are taught to use to determine the progress of labour is the great “timing the contraction” ritual.
When a woman begins to feel like she’s in labour, what’s the first thing she’s taught to do? Time the contractions. What is UP with that?! To what end? In most books and in most classes, women are taught to go to the hospital when their contractions are 4-5 minutes apart, are lasting 45 seconds to a minute, and have been doing so for a couple of hours. Not being able to speak through them is also suggested, but people get so caught up in those numbers, they ignore that second bit of advice.
I tell people to NOT time contractions, at least for the first part of labour, anyway. It’s a tool, like any other, but should never be used on its own. What’s the best way to make something “bigger?” Pay all kinds of attention to it, and worry about whether or not your process is comparatively normal and “fits in”. So by the time contractions hit the magic number (if they ever do, as some don’t), a woman thinks she’s really getting somewhere and is usually figuring she’s in some kind of active labour when she gets to the hospital. This is because the numbers game has set up an expectation, which, in my years of experience simply observing labour, can make for harsh reality checks. Women who are taught to time their contractions as the primary tool for determining how labour is progressing often are the ones who end up saying, “my labour was SO long! I was in labour for 36 hours!” (which is actually not abnormal for a first time mom taking into account all the contractions). Those who choose not to pay much mind to their contractions until it is clear they are absolutely requiring attention tend to perceive their labours as shorter and more manageable.
Lots and lots of women walk into that hospital chatting and smiling, able to analyse their contractions, misled to believing they’re just a few hours away from birthing, because they’ve been given a formula within which to fit their labours. Then when they’re examined and told they have ages to go, they get discouraged, and the cascade of intervention begins. How disheartening it is to think your cervix “must” be at a certain amount of dilatation, and you discover in truth, you are only just starting out. Women end up believing they are defective in their birth giving capabilities, when it’s simply not true. It was just the expectation that was not realistic.
I have had women call me saying, “My contractions are 2 minutes apart! I guess I should go to the hospital now, right?” I’ll ask, “Are you having one now?” And they’ll answer, “Oh, yes, I’m having one now while we speak.” Well, just because one is having frequent contractions doesn’t mean the baby is coming! I will be encouraging and tell her she’s doing great, but that if she can talk through her contractions, it’s probably better to have a bath and go to bed. Even though I educate all my ladies about how not to use timing contractions as a reliable tool for diagnosing labour progress on its own, it is so pounded into our over-thinky, information obsessed, numbers loving brains, it is a very hard concept to let go of. We are terrified our babies will fall out of us unwittingly at home or en route if we don’t keep track. Many first time parents are so afraid of not making it the hospital on time. While very fast birth is possible even for a first time mom, the VAST majority of women go to the hospital too early as opposed to too late.
Let’s also stop to consider those whose contractions never get closer together than 5 or 6 minutes. I have seen this happen many times. I’m sure some of you experienced midwives and doulas have seen the occasional woman start out with frequent contractions that go on for awhile, and then it’s only when they get farther apart the contractions strengthen enough for the cervix to start doing most of its work. For some ladies, if you wait until contractions are five minutes apart, they’re going to birth unassisted (which is not the worst thing in the world for most women..but remember, I work with a mostly hospital birthing population who are very attached, understandably, to being in their chosen place of birth).
Instead of looking at the clock, observe the woman. Listen to her. If a dad calls me and announces the contractions are matching some formulaic expectation and I can hear the mom chatting excitedly and barely cracking a sweat during the contraction, I tell them to stay home if they can. Very often they’ll call me hours later, and even though the contractions may or may not be different in terms of length and frequency, I’ll hear a change. She will be vocalizing in some way, or doing some very focused breathing…her voice will sound a little far away even between the contractions. If I’m present and watching her, her motions will be slower, and more deliberate. She’ll have to lean over things and sway her hips. When labour is really rocking and rolling, most women will look quite stoned between their contractions, the idea of distracting themselves by conversing or watching tv ridiculous, and there is a sense they are far away, off in labour land, and moving normally is often difficult. Plus it’s aparent they are feeling some spectacularly strong sensations. For first time mothers, this is usually the time to go to the hospital, because labour has had a chance to establish itself…endorphins and oxytocin are flowing beautifully. If a woman goes to the hospital too much before this happens, it can be EXTREMELY difficult to achieve this trance-like state with all the routines and strangers asking questions, often making the labour seem longer and more painful.
At home is where the woman usually finds her power, and is able to bring it to the hospital with her. Labour usually reaches a pivotal point and becomes a little less sensitive to petering out with the initial hospital admitting routine, though some women are very sensitive, and their hormone groove is easily disrupted. But in my experience, women who choose to hospital birth because it’s where they feel safe and go when they’re in really good labour, there may be a little lull upon arrival, but quickly labour revs up even more strongly because now they feel safe and settled (which contributes to the beautiful symphony of birth hormones). This is more reliable when the staff are friendly and respectful, doing their jobs as “invisibly” as possible. It is easier to re-establish labour in most cases than it is to get it going in the first place.
So when you go into labour, resist the compulsion to rely on the clock or trust a “curve”. Do not mistrust your own sense of when you need to get going. Even the concept of “regular” contractions is not so reliable on its own. It is NOT absolutely necessary to have regular contractions to birth your baby. Some ladies’ labours sneak up on them, it’s true, but for first time mothers this is RARE. A woman and her partner will usually know that labour is advancing, without little stopwatches and numbers chicken skratched onto scraps of paper. Things feel faster, seem longer, are obviously more INTENSE. With all the other cues labour has to offer which TELL you, “Folks, get somewhere safe and comfortable for you!” you will understand that observing is more reliable than timing.
Because about 95% of my mothers having subsequent babies with me have fast, natural labours, I tell them to let me know right away when their contractions make them double over and go, “ohhhh yeah, I remember this…this is HARD.” Because things often move very quickly from there. And I don’t care HOW far apart the contractions are. I had a woman not long ago do with contractions about 8 minutes apart. The hospital didn’t want to admit her. She had her baby an hour later. TRUST THE WOMAN!
by MotherWit | Jan 27, 2010 | Uncategorized
Well, look at that! Not much to say today. I am feeling a little tired. I have the house to myself, no children here, no postpartum or prenatal meetings to attend until tomorrow. I think I will leave the mounds of dishes and unfolded laundry, and take a nap. I’m pretty darn sure I will not have a birth today…just a feeling…so perhaps I will sleep for a few minutes without my phone ringing.
I am very much looking forward to going out this evening for Ethiopian food with a dear friend. It has been awhile I’ve gone out to do something social and just for fun. It is never easy to find balance in one’s life when you know at any moment you may have to adjust your entire day. I personally like this kind of life…I will have plenty of time for routine and stability when I’m too old to doula anymore (like 109 or so). But getting in time for all one needs to maintain a balanced life, like consistently healthy meals, exercise, decent sleep, family/husband time, housework, friend time, and soul work? I’ll let you know when I have that figured out. I told an OB at the hospital yesterday my eldest child was almost 18, and she was surprised, asking me how I stayed so young looking, and what sort of facial products did I use? “Vernix,” I said. And as for lifestyle, many late nights and a lotta coffee are a major part of my youth maintaining regime.
I have spent the morning working on the FAQ parts of my website, which is coming together more concretely, finally…can’t WAIT for it to be done. The masculine counterpart to MotherWit is busy at work getting the infrastructure together while I do the content writing and the woman’s work of birth attending. I am very grateful for all the help and advice. I do notice that a man’s idea of what a website for mostly women should be like is a little different from mine 🙂 I am going to stick to my guns about certain things, and if it doesn’t work, will be gracious about the good natured “I TOLD you so!” Thank God for “computer-y” people!
Off for a snooze. Happy Wednesday!
