by MotherWit | Apr 29, 2011 | Uncategorized
Firstly, before anyone decides this is a rant against epidurals, let me explain. I am emphatically NOT anti-epidural. You cannot work in birth for nearly two decades and be anti-epidural. Just because I’m a doula, the very word conjuring up images of bowls of organic granola lovingly moistened by the milk of the goat who lives in my back yard, do not assume I am all about all natural birth all the time. Ultimately, I am about whatever works and women’s choices. Just to be clear.
Before exploring some of the questions I’ve heard people ask in response to the shocking idea of natural birth, let me defend the poor old epidural for a moment. Everyone who has worked in a hospital birthing culture for a reasonable amount of time has seen how an epidural can potentially and sometimes even miraculously restore morale and labour efficiency to a woman who has been labouring hard for a long time with the discouraging news that she is not opening. We all have stories of women who stayed at home for a couple of days with contractions strong enough to make them vocalize loudly. You know, the kind that look like the baby should be coming soon but just isn’t, so they decide at their limit to accept an epidural when they find out that the three centimetres dilated cervix their doctors told them they had 2 days before they even went into labour has not budged in the 72 hours of minute long contractions every few minutes they’ve been having. And then boom, she goes to 10cm in 30 minutes after a break in pain. Could it be there was a real physiological need for the epidural and its benefits of relaxation? Maybe. Could it have been a psychological thing? Perhaps. Could this be a product of our enculturation? Sure, why not? Regardless, it worked, and the baby came vaginally, an epidural being less of a risk and less of an invasive intervention than abdmonial surgery. So let us give credit where it is due and a round of applause to this brilliant invention that can and does help some mothers’ births proceed a little more normally sometimes. Sure, most babies would come out given enough time. But in cases like that you might start to ask “at what cost?” Sometimes, one might need to admit that in the the odd case the benefit of an epidural outweighs the risks of a labour continuing the way it is. Sometimes no matter what stops the support team pulls out to help labour progress more normally, from emotional support to comfort measures, to maternal positioning, to bodywork, to homeopathy, to down and dirty emotional/spiritual excavation, our efforts do not magically produce a baby. Nobody is to blame. And you can look for the “whys” and “wherefores” all you want, but in that moment that’s not necessarily the healing thing to do. In these cases, sometimes the epidural is the most compassionate and effective healing tool.
It is also important to emphasize that doulas are not anti-intervention, they are pro choice. If a woman is truly and fully informed of the risks and the benefits of routine epidural (those risks can be found within seconds on the internet for those not in the know) yet in spite of that knowledge still claims she will want an epidural because she knows herself and her relationship to pain, then it is not our business to judge her. Sometimes getting to the bottom of what is often fear helps her to move through that desire and she ends up birthing perfectly normally. Sometimes not. It is our job to support her with as much love and enthusiasm as someone going for those natural births we tend to like. It is simply not true that a woman will only choose a routine epidural out of ignorance and an unwillingness to let go of a sense of control and propriety. You still grunt, cry, bleed, and poop with an epidural…sometimes for longer than you would without it. Yet even when this is explained, some still want it. I tell women it is totally normal to bellow up a storm while in good labour, that of COURSE it’s fine and even desireable to make some noise, as how would you and a baby, if you found yourself accidentally birthing in the forest, keep those blood thirsty carnivores away without your yells scaring the crap out of them? Even with that doula-logic instilled, some still want that epidural. Fair enough. Everyone has their reasons, and everyone deserves to have their decisions understood and respected when it comes to pain relief in labour. I do my best to educate, and if we want to remain in the spirit of true empowerment, we stand by the choices our clients make for their coping methods. Period.
So I just want to take a moment to explore the question, “Why don’t you just take the epidural?”
Here are some of the thoughts I’ve heard people express on the subject.
1) “If there is all this pain relieving technology out there, why wouldn’t you just take the epidural?” It is understandable that most people in our western birthing culture cannot understand why on earth a woman would want to go through that pain when they didn’t have to. The spirit of this question is usually meant with compassion, an expression of curiosity around the idea of why one would choose to take the pain filled jourey of childbirth as opposed to the much more comfortable one.
This speaks to a fundamental lack of understanding of the benefits of natural childbirth. The pain is not just some inconvenient by-product of the process, it is what helps to conduct the flow of hormones. You contract, you hurt, you get more oxytocin, you hurt even more, and so on. If you’re feeling okay and nobody is bugging you, this flow is usually not interrupted and the baby is born. If it is constantly interrupted by routines and a demand on the intellectual as opposed to mammalian part of your brain (like timing contractions, grrr, and strident heart monitoring protocols), things may feel more painful and be less effective. And the opposite can be true in some cases as well. Birth can be fickle and it can not give a crap about what’s going on externally. It is too unpredictable to pin down. Contrary to popular belief, I have not seen this pain phenomenon make women automatically turn into crazed evil banshees, lashing out at their partners for ever having impregnated them. That’s media education for you. For the most part, if the mother feels safe and well supported, I usually see the oxytocin make them behave very lovinginly and trustingly, and sweetly spoken. Even at 9cm of dilation, the vast majority of women are grasping me tightly, apologizing for possibly having hurt me, murmuring how glad they are I’m there, and I kid you not, I have even been told “I love you” on more numerous occasions than you would believe in such an intensely painful situation.
My neighbour has the mouth of truck driver, God love ‘er. Her husband was terrified she would totally alienate the hospital staff when the pain of labour hit and made her start swearing a blue streak. Well, wouldn’t you know, labour came, she did it naturally, and all her words were sweet and grateful. Not that labouring women don’t let out a few choice curse words here and there…sure they do and that is fantastic. It’s good to vent now and then. They get pissed off that the baby’s not coming quickly enough or bummed out when someone is not doing what they need them to even though she has told them five times. But that brief annoyance is usually not directed at anybody in the anger you might expect of someone in a lot of pain. Put it this way, I have been hugged 99% more times than smacked while helping someone in labour, so, given the intensity of the sensation (been there, so I know what I’m talking about), you’ve got to figure the hormones must have some effect on that.
This oxytocin, when the baby and then placenta comes out, is as it’s peak. The whole room seems jacked up to the hilt on the stuff. It’s beautiful. When the baby arrives, usually most of the pain is gone immediately, relief sets in, and in a couple of days when the body memory fades, women say, “Oh my God, that was AMAZING! I would do that again.” It is discombubulating if you’re not aware of the beauty and power of natural birth, even when it looks INTENSE. You might think the mother is some kind of masochist given what you’ve just see her go through. But regardless, they usually do go on and do it naturally again if they’ve done it before. I have. Four times. In spite of the yelling and feeling like you’ll never make it. In spite of sensation that makes you think you will never be able to contain it in one little body. In spite of the exhaustion, shaking, and nausea. In spite of the nine months of pregnancy challenges and discomforts. You most likely choose to do it that way again if it worked out for you before. And hey, even women who have had really tough, intervention filled experiences usually give birth again, many, even though they may have been those ones stuck for days at 3 cm with howler contractions and no progress, go into it the next time with the intent of doing it naturally.
So why do some women choose to do it naturally, whether they are first timers, have had a natural birth before, or have had terrible experiences before? It’s not just because of the known health benefits of not messing with this particular blue print Nature has given to us if it’s not warranted, but I guess because at the end of a good birthing journey, there’s a body knowing, a deep soul intuition, a flash of motherwit if you will, that occurs when a birth has gone normally. It bestows upon your being a sense of rightness. In spite of all the judgements of “you’re crazy.” It just feels…right. It is what glory feels like. Labour is not something you love while you’re doing it most of the time. You love it when it’s done. It is at the same time the hardest and the best day of your life. Up and down, ebb and flow, effort and rest, give and take, scream and love.
2) “You wouldn’t have root canal without anesthesia, would you? Why on earth would you have a baby without drugs if it hurts that much?”
This analogy bugs me to no end. It’s stupid, even though it’s asked if YOU’RE stupid. Sorry to those who like to use it. Root canal is a procedure dealing with a pathology. In your mouth. Someone is doing it to you to help you with something in you that is sick, impacted, and potentially rotten. If you want to put the intended nature of that question into its proper context, you should ask, “You wouldn’t have a Cesarean without anesthesia, would you? So why would you have a vaginal birth naturally if it hurts so much?” But then you’d sound like a total tool, as the intention of Cesarean is to quickly remove a baby from a mother if one or both of them is in mortal danger (well, that’s what it used to be for, anyway); normal vaginal birth is…well, normal, even with the level of pain usually involved.
Women have been birthing for a scabillion years. In fact, you, yes you, would not be here today if you did not come from ancestors who, from the beginning of time, birthed vaginally without epidurals. Even if your great grandmother and mother had a little help, or you were conceived in a petrie dish, it still means that (at least up ’til a couple of generations or so ago) you come from a line that can be drawn back to the dawn of birthing humanity in which they rocked birth old school. Yeah, we may have lost a mom here and there along the way. The benefit of living in the now is that maternal death happens less frequently in developed countries (though with all the stats on the impact of all this surgical birth on maternal health, even that is seeming sketchy). You may have lost a lot of great great great uncles and aunts over time. But you are here. How many births have occured in your ancestral line to get YOU here? Millions? Is this not a testament to the birth giving brilliance of your Grandmothers’ bodies? And if you want to use the evolution/big fetal head argument on me, you’re barking up the wrong tree. The poor old decrepit female pelvis is probably not to blame for what seems to be more difficult births and all these interventions to save us from the pain and death invading us from all sides. It’s probably a combo of fear, enculturation, detachment from our bodies, sitting on our butts all the time, pain management messing with our hormones and muscles, birthing positions that are antithetical to simple mechanics, lack of real emotional support as everyone pays more attention to drama and danger, and a bunch of numerous other things I’ll just get too mad about if I start writing about them now. The point of the whole “root canal/childbirth” analogy is that it needs to be put to rest because it is just an insult to one’s intelligence and a spitting on the honour of our Grandmothers.
3) “Isn’t wanting to give birth naturally just a display of feminine machismo?”
I have sat outside rooms beside a couple of male doctors, with the woman inside the room yelling and keening with her birthing pains, ask me that very question. I am not picking on male doctors, as I have known women to say this too…about other women. This feels even worse to me. Anyway, in these cases, I could sense the doctor was having a hard time not wanting to save the woman from what clearly sounded like abject suffering. The tension from hearing these sounds when there is a perfectly good Epidural Man walking around the hallways administering sweet pain relief can be a lot for many people, medical or otherwise, and they start to wonder as their stress builds, “well, if it really hurts that much, isn’t kind of stupid to suffer like that? She can’t give birth with all that tension. She’s hurting herself and the baby. This is all ego based posturing so everyone can tell her what a hero she is afterwards.” I invite those with this belief to reclaim their projections. Part of them is saying, “I want you to end your pain because I can’t handle it.” Trust me from many years of working with natural birth when I say that the most hard core natural birther will call for help when she has reached her limit. No thoughts of heroism intrude upon a woman who is in truly dysfunctional labour. It is obvious in one’s deepest core that something isn’t working that great. She stops being all trance-y and stoned with the contractions and the bad kind of adrenaline starts working, and she starts getting more intellectual about things. I myself have been in that space wondering, “hmmmm…I may need to think about plan B”. We don’t push ourselves to the limit or go about trying to prove a point at all cost. Nobody wants to put their babies or themselves at true risk. We push ourselves to the limit because we’re handling it and we’re strong, thank you very much.
Let us be clear about one thing. We as a culture use the phrase, “you don’t have to be a hero” to women who state their intentions to have a natural birth. What we really mean is “don’t be a martyr”. A hero shines in beneficence and helps heal our world on various levels. Is it wrong to be a hero, for ourselves, for our babies? Is it wrong to want to create new legacies for our future birthing daughters and to embody the magnificence of normal birth to caregivers who rarely see it? Is it wrong to want to be a pioneer again? Is it wrong to want to reclaim a little faith in our bodies our culture views as defunct? Does that warrant this judgement of intended machoism? Is this how resentful people are of women who want to have natural births, that they will think them as megalomaniacs for going through the pain involved? If we were quiet about the pain would they feel differently? A martyr is someone who dies for her cause. I have never ever known a woman who would not throw herself on the floor and subject herself to unanesthetized surgery if there was evidence her baby was in immediate danger. This is not to say people don’t sometimes make bad choices. It happens. But if we’re talking about owning the sensations of labour, if a woman is paining, it doesn’t mean she’s dying, it means she is expressing a tremendous amount of raw, natural power. She is WORKING it. And if you can’t stand the heat, you should get the hell out of the kitchen. When she’s labouring she needs support and encouragement like the marathon runner who is at mile nineteen and all systems look to be shutting down. She doesn’t need jugement about her intentions. Trust that if she can’t take it or if there’s danger, she’ll do what she needs to do. That whole “feminist machismo” assumption is one of the most disempowering things I have ever heard, and it speaks of how little we regard the process that gets us here and those who have laboured to do so in heroic, miraculous grace. It speaks of a woman’s intentions to experience birthing pain as misguided, and of not being smart enough and too stubborn to seek help when needed. Shame on us.
To be honest, there IS a tremendous ego boost to having birthed naturally. Huge. But it’s a healthy one, not the macho kind. After that baby has come out naturally and you realize you did it all on your own steam you usually feel like a consummate badass. And is that so wrong? You haven’t done it at anyone’s expense, in fact, it has contributed to your and your baby’s health. Shouldn’t it be okay to feel great about that? In my doula logic I believe the confidence boost a woman receives from either having a great normal birth, or a difficult birth in which she may have needed interventions for but gave what she felt was her all, is one of the best springboards from which to leap into motherhood. Motherhood is joyful and amazing, but it’s hard. And it’s forever. To start out that relationship feeling like you can do anything, gives you RESOURCES. There is no Epidural Fairy who comes in the middle of the night to save your ass when your nipples hurt and the baby is waking up for the fifth time in a row. You are struggling, but you remember: you have given birth. You can do anything.
I ran into another neighbour of mine walking with her toddler and her new baby. Her first birth had been very long and she had had an epidural. She felt like she did great, but was a bit disappointed how it turned out. She wasn’t sure she wanted to try it naturally again, but ended up doing so.
Lesley: “Jen, you had your baby! That’s so great! How did it go?”
Jen (beaming): “I did it NATURALLY!”
Lesley: “Yay, that’s fantastic, good for you! Do you feel like a rock star?”
Jen: “I AM a rock star. I feel like I could fly”.
Enough said. “In glory and awe I have given birth, and found therein, my Self, my Child, and my God.” -Kim Miller
by MotherWit | Apr 22, 2011 | Uncategorized
Doulas are known to be extremely accommodating. We commit ourselves to staying at births no matter how long they are. That means slipping from our beds at 3am, without knowing as doctors, nurses, and many midwives do, when we will be home. If the birth is 3 hours, 30 hours, or 3 days, so be it. We are there. We quietly dip outside the birthing room with our cell phones when the sun rises and there is a lull in labour to reschedule our day packed with pre/post natals and re-arrange our childcare that becomes necessary after a couple of days away. Ah, there goes the day off planned for the week, and if the birth is really long, there goes the day off next week too in order to catch up on meetings. If the birth is super long and someone else went into labour early despite your attempts at good scheduling and you have to send a backup, well, there goes that income you had planned on too. It is crazy work, and it takes a very strong and giving spirit to do it happily without burnout. Thankfully, the rewards of birth attending are HUGE. I come home after a great birth or prenatal meeting high on good feelings of connection and the knowledge that I am doing something meaningful with my life.
The nature of a doula is usually one of givingness. To everyone. This can leave us sometimes feeling like we’re failing everyone, our clients and our families, because we cannot clone ourselves and be fully present for all those people in our lives. It is extremely important, and you will see this as you grow into the work, that boundaries surrounding your pre/post natal meeting hours are essential.
I have kids in school. To see them off to school is important. To be there when they get home or soon after is important to me and to them. This is because usually at least once per week they miss me for a good chunk of time. Sometimes, like this week, there were three evenings in which I was there for neither after school nor bed time. This is hard on kids. It is crucial to find balance.
I schedule my meetings during school hours, from 10 to 3. This is not necessarily convenient for many clients who work, but as they usually take periods of time off once in a while to see their doctors or midwives, I usually suggest booking me in when they have that time off. I do not work (unless it’s a birth or an event like a “Meet the Doula” night or apprentice gathering) evenings or weekends unless it is absolutely urgent. Sometimes I cave and meet with people at 9am or at 4pm. This is often NOT good for my family. I have to police myself firmly to not make that a habit. I arrived home at 3am one day this week, with a meeting scheduled at 9am. Constitutionally, I can stay up for 2 nights, down a coffee, and teach a 9 hour long doula training workshop without much issue. But it’s not about me and keeping my schedule at this point. I realized if I made my 9am, which I should not have scheduled anyway, which I did out of guilt for not seeming accommodating enough to my beloved clients who work hard to schedule with me, that would be a LONG time away from my family. The after school, the dinner, the night time, AND the morning before school….for the second day in a row with many other births coming up, was getting a bit much. Those precious couple of hours to snuggle and catch up with our children, from toddlers to teens, are what nourish us all. We can go back to our work knowing everyone feels somewhat tended to if there is that reconnection to the home and hearth.
Another thing that makes not keeping schedules a total drag for my family is how hard my husband has to work to hold down the fort. He has his own stressful job. It’s nine to five most of the time, but when you start feeling like a single dad of four, doing all the cooking, cleaning and child minding instead of his regular share so I can work, this can be a tremendous strain. He is the best doula husband ever. It is no easy feat being a doula’s partner. His patience for my crazy birth attending hours has widened a lot over the years as he honours the importance of my job. But when it comes to sneaking in those little extra meeting hours in? No. Patience goes out the window, and I don’t blame him. It’s not only the days I’m not there, but if I arrive from a long birth at 8am, I usually need to sleep a bit, which means more time he is “on”. He takes it in stride gracefully, and I am really grateful for that, but I totally understand why sneaking in those 4pm meetings, leaving supper to him AGAIN is a starting to ask a lot.
When we’re starting out as doulas we’re just so thrilled we get to go to births, and tend to bend over backwards to run any time and any place our clients want us to be so they are happy with us. As your practice grows, you will need to keep that in check and figure out what will work for your family and what will not. Yes, it is true, some clients may not hire you because they simply cannot make those day time meetings, but that’s okay. I have a large enough practice that when one one client cannot take me, there are usually several more willing to take their place, and that will eventually happen for you to. There is a strength and grace and professionalism about someone who keeps strong boundaries. As doulas, we model mothering to our clients. To model the importance of family and boundaries is all part of the work.
And don’t forget, there is not just work and family, there is you too. I always try to schedule a day off for my self during the week. I catch up on sleep, take long walks with the dog, go shopping, go for a long run along the lake shore, etc. It often doesn’t work out because of births necessitating rescheduling of appointments, but when it does, I have to FIGHT the urge to sit down and work on administrative stuff or tend to all those little work-y things I “should” be doing. If I am going to model to my new mothers that self care is essential to harmonious parenting, and that they must “sleep when the baby sleeps” and not worry about messes and loose ends at work when there is a moment to chill out, I have to walk that walk too, otherwise my message is empty. I can only find true balance when my own self feels nourished enough to have plenty to give away.
As hard as it is finding balance as a doula, while I have my moments of stress and overwhelm, I do feel satisfied with most aspects of my life. I love my family and I love my work. And oh, I love my time to myself. If I don’t get to be alone with my self or with my husband sometimes nothing runs as well. When guilt entered our culture for self-nourishment I’m not sure, but it is the ugly demon we need to keep fighting off in order live peaceful lives. Sitting in front of the tv in jammies on Sunday night is healing. Lying in bed reading a trashy novel when the house is a mess is a spiritual practice. Spontaneous kitchen messes with the kids are godly. Mother and work your heart out, sure, but have fun too.
by MotherWit | Apr 8, 2011 | Uncategorized
I have been noticing in the doula world some stuggles over words. We have so much to do, so many balances to create, so many environments to improve. Some of these struggles are completely spot on and need addressing. Some verge on what seem to be an attempt to be more unique or less mainstream than the average bear. Words most definitely have the power to make us distinct. Language is very important, no doubt. If I’m standing up strongly for myself and creating a stink over injustice, I don’t like to be called a bitch. Calling someone “sweetheart” in a way that’s clearly condescening and sexist, instead of in a loving, nurturing way is awful.
There is tremendous power in words and we do need to be careful. But sometimes quibbles can be much ado about nothing. Yes, apparently I am waxing Shakespearean this evening. I don’t love the quibble over the word “contraction”. Yes, while the endorphin suffused state of birth in no way feels emotionally like a contraction but an expansion of consciousness, in reality the uterus most certainly contracts. Hard. Calling it a wave or an energy rush is not a bad thing, but really, it doesn’t change the fact that a uterine contraction is occuring. Calling it another name might make it seem less “hard” (I consider it to be a word referring more to simple mechanics than to Medicine) and perhaps more spiritual, (and in our culture this desire for a shift of balance in birth perception is certainly helpful for many), but I am perfectly comfortable with “contraction”. The uterine contraction causes a heck of a lot of sensation, and while I understand this phenomenon is perhaps not what some people want to focus on in their birth experience, really, that big sensation which goes hand in hand with the mechanical uterine contractions seems to take center stage in most labours regardless of what we plan or hope for.
I have noticed that many people don’t like to use the “p” word with regards to labour…you know what I’m talking about…..pain. There have been several terms generated to shift perception surrounding the birthing sensations, but in my humble experience both personal and in birth attending, I tend to believe birth hurts, no matter how you try to pretty up the word. But the pain isn’t a bad thing. That strong, strong sensation creates the flow of endorphins, and our experience of it raises oxytocin levels so the next contraction is even STRONGER. We birth hopped up on that beautiful ” ‘ormone of luve”, which is guided and driven by…you guessed it, pain. Whether they plan to or not, the vast majority of women feel some level of pain in labour. Instead of quibbling about the word, perhaps shifting the focus from the pain as being some nasty by-product of the childbearing process that we “shouldn’t” have to suffer through to being a noble, healthy challenge we are absolutely capable of moving through would be more helpful. Call it an interesting sensation, call it a wave, sure…that doesn’t hurt. But the sensation still does. And that’s okay.
I see more and more doulas not seeming to like the word “training” for the process by which doulas learn their skills. The definition of training is: “organized activity aimed at imparting information and/or instructions to improve the recipient’s performance or to help him or her attain a required level of knowledge or skill.” I believe in training. Where I veer from most doula training organizations is that while I believe in good training including apprenticeship with an experienced doula, I don’t care much about certification one way or another. In the doula world that piece of paper, while it is great because it means you did what was asked according to someone’s made up standards, it in NO way means you’re “done” learning. It in no way defines the greatness of a doula. Frankly, it means little to me. I have doulas on my team who are certified and who are not. What attracts me to them is their integrity, reliableness, passion, compassion, and a sense of knowledge I get from them just by speaking to them casually about birth. We develop through constant learning and continuing experience. So while the piece of paper stating “qualifications”is not so important to me, the fact they took the time to invest and immerse themselves into the preparation or “training” of how to be a doula is. There is a basic level of skill being a doula needs. I don’t want to say “required” because that’s too rigid. While the learning is life long, there are basics to know. You might want to know what a cervix is, for example. You need to know how to listen actively. You need to understand the process of labour and how women experience it. You need to know some tools to help. It’s not all hearts and flowers and broadcasting love. So doula courses DO train doulas. Whether we want to claim that word “train”or not as what we do to prepare doulas is up to us, but I am happy with the word. I do not consider it too mainstream. I don’t think it necessarily leads to an assumption of a means to an “end” of learning and major standard of pratice focus over skills. I don’t believe it’s about a check list of qualifications so you can call yourself a doula. It’s about basic skills, information, and personal growth so that all participants can find their unique path and expression of the work. I’m sticking to the term “training” with impunity because I think it’s a good word for the process of learning basic doula skills.
I’m not so down with the term “delivery” for the receiving of babies. What I don’t like about it is that it implies the attendant “delivers” the baby. While they may be actively helping in some cases (whether it’s needed in that situation or not), I’ve always kind of felt that mothers deliver their babies into the world. But I won’t argue with or correct someone who uses this term.
You know what word I really don’t like? “Doula”! It rubs me in all kinds of wrong ways. It comes from the Ancient Greek word “slave”, for crying out loud! And a bonded slave at that. While the ancient lady of the house was birthing and mothering, her maidservant hung out with her and carried out a very noble role, but maybe not necessarily with the love and passion we modern doulas bring to our work because we do it from a place of free will and choice. To tend to women in their childbearing year is an honour. But the ancient maidservant was probably bought into the family and would have been stoned to death if she didn’t carry out her role, like it or not. I can’t think of one great other word describing what I do, but I must say it has never fell comfortably out of my mouth. Dooooouuuullllaaaaaa. It sounds kinda flakey to me..even a little romantic. Plus, half the people you mention it to say, “say what?” But hey, it is very deeply entrenched in our modern language, so instead of quibbling about it, I just go with it. It doesn’t really change my life so much. Whether I’m called a doula or a birth attendant or an accompagnante, I love the role I play. A doula, the essence of the work being summed up by this popular word, is what I choose to call myself, whether I dig the acutal term or not. It’s what people know and respond to. Really, “a rose by any other name would smell as sweet.”
Lesley
by MotherWit | Mar 28, 2011 | Uncategorized
I re-read Ina May’s Guide to Childbirth, and have read Spiritual Midwifery at least 10 times over the last couple of decades. The message that always resonates most with me is that culture helps to shape birth. It is true to a large degree how something is observed influences how that thing functions or “behaves”.
Ina May lives in a culture she has contributed to forming in which birth is a normal, natural, exciting, joyful, transition into motherhood…that women are powerful both in their birthing prowess and in the strength of the support they provide to the birthing women in their community. Her amazing stats bear this out, showing evidence for the efficacy of this woman centred rather than technological approach to birth. There is very little in the birth stories Ina May features in her books that cannot be remedied by the loving and strong support of the spiritual midwives and other women close to the couple. Of COURSE the unexpected and even the dangerous can and does happen on occasion, even on the Farm. But for the most part her statistics tell a much different story than standard North American birth stories, that many issues that come up in labour can be resolved with more emotional support and spiritual excavation rather than medical intervention (not eschewing, of course, good medical care when necessary). Again, bear in mind those phenomenal outcome stats before pooh poohing.
The birthing culture I live in now is way different. My “culture” when I was having my babies consisted of a community which favoured home birth, home schooling, natural approaches to health, bed sharing, etc.. The far reaching majority of us had pretty straightforward home births, easy breastfeeding, and good postpartum support from friends. I don’t think any of us had Cesareans, whereas now you can’t throw a stick without hitting someone who’s given birth surgically. What used to be considered a major thing is now becoming a norm. We held Blessingway ceremonies for each other during pregnancy and hung out a lot telling good birth stories and providing each other with emotional support. It was a beautiful time. Now these children we birthed and nourished are growing fast, many of them already grown. I pray our practices stick with them as they make their way through the ups and downs of today’s North American birth culture.
It has been said that form follows function and function follows form. As above, so below. When our culture has such an overwhelming fear of the birth process, it makes sense this seems to be reflected in our birth outcome statistics. For all our shiny technology, our outcomes are pretty poor compared to Ina May’s at the Farm. So many births seem to need epidurals and Cesareans despite the woman’s best intentions. Women are told they couldn’t have had a safe birth without their interventions. The poor old female pelvis is not the all powerful thing we seem to pay lip service to after viewing all those great birth documentaries, but apparently, according to our North American stats, an unpredictable lemon. When it works naturally, it’s an awe and triumph, not really the norm. A natural birth is a rarity. In fact, in our present birth culture, natural birth is often seen as radical, sometimes even held in contempt not just by some of the medical community, but by many of the women themselves. This breaks my heart as it demonstrates a terrible collective misguidedness.
The way we prepare women for birth is so intellectual. Breathing techniques often consist of counting. Women seek to hypnotize themselves out of a fear response to the normal sensations of birth! I see women reading all the right books and wanting the image of that dream birth yet still buying the cultural fear so much that they will almost always in the end go for that 41 week induction for terror of sudden fetal death, or go to that hospital with 24 hour on call anesthesia just in case they can’t handle it, but without exploring what “can’t handle it” means. They get mad at their doctors sometimes for delivering the information and treatment outlines to them (and I don’t blame them much of the time, as this information can sometimes be delivered in ways that make them feel like bad, neglectful parents if they don’t do what they’re told). In the end though, nobody goes to their houses, holds their faith in their bodies hostage, and takes them at gunpoint off to their intervention filled births. We must recognize that there is some choice here, and that we must own for the most part that which we make informed choices about. These choices shape our culture.
It is a hard thing for women in this culture to bear, and one that I believe to very much affect the mechanics and juicy hormones of birth: on the one hand you want a great natural birth inspired by the good stories and films out there, but on the other you ultimately feel you must trust Medicine as the last word and a very fear based aggressive approach, feeling backed into a corner and possibly resentful, yet unwilling (or in many cases unable due to lack of resources) to make different choices because of…you guessed it…the very fear that makes Medicine outline those choices. We are terrified of the unknown and for being responsible for choosing something that may ultimately make us suffer the horror of having hurt our babies. Medicine is afraid of the repercussion of uncontrolled choice as much as we are….thus everyone feeds off the fear and it continues to spiral out of control, to the extent that in some North American hospitals the Cesarean rate is over 50%. We keep choosing the more medical approach DESPITE the rather grim statistics (ie.: definitely not like Ina May’s)which seem to illustrate that the more we mess with normal birth the more problems we seem to cause. YES, Medicine saves lives, and God bless it! YES, sometimes things happen out of the blue that necessitate quick and immediate medical care. And for that reason, though those quick emergencies are pretty rare (I sound like a broken record, but I again defer to Ina May’s gorgeous stats), we continue to take calculated, controlled risks to our normal births, very likely causing more problems than would need to be treated if we didn’t interfere so much with this process.
It is very hard to bring the Ina May approach into the hospital. Her approach is about trusting ourselves, the process, and the support. Her brand of midwifery is certainly wise and vigilant (again, check out the great birth outcomes), but it is dynamic and views the woman as a whole, not a check mark on the all mighty progress chart or an alarm bell going off when anything is not “average”. Not that doctors are uncompassionate and uncaring…on the contrary, their choices are usually motivated by a lot of care. Ultimately, though, clinical responsibility and covering all contingencies is the absolute priority. That’s the way it is. The Farm midwives know the relationship of the couple, know who’s visiting whose hut, know the diet well….our doctors are not aware of these factors and cannot offer support that way. They are busy preventing and treating the many emergencies, which is not a bad thing.
So where do we find balance? While a doula certainly provides the loving, guiding aspect of support the Farm midwives do, we usually do so in the hospital. This is not the lovely home environment of Ina May’s birth stories our clients read about and are inspired by. Instead, their births unfold in an environment that is saturated with the fear of all the bad things that can happen, the fear of not making all the right choices to save a baby’s life, and an endless sea of strange faces coming and going and commenting. Having a doula present doesn’t magically erase the heaviness of this environment. Surely we help. It is true our clients have less Cesareans and epidurals, but to believe their births will be like the ones on the Farm with the support of a doula within the hospital environment is simply not true. Doula or not, the pervading institutional-ness of the hospital will have a profound effect upon more sensitive physiologies, potentially creating in the end what will be a real need for interventions.
A doula’s emotional support is powerful, it is true, and can reduce anxiety thus a need for many interventions, but our support can easily be undone by many different things….a shift change, another bit of information about the labour that requires a mom to be on a monitor more and frightened, an insensitive vaginal exam… A sensitive woman will definitely be thrown by a well meaning but misplaced comment or harsh word no matter the buffering power of her doula’s word medicine.
I have seen the environment shut down a great labour despite my attempts, and this can make us feel really powerless sometimes. Sure, sometimes you are very grateful as a doula you were at the hospital because of a truly unforseen emergency. But often you have a sneaking suspicion that a little privacy and a little time off the monitor would have turned a “stalled” labour around instead of the epidural that was sold so hard you’re all left reeling. And even though the labouring woman knows this on one level, fear of not doing what’s suggested often bears out and influences her choices…which influences her labour….which co creates the bigger picture of our birth culture.
Luckily, we doulas have FAR more great stories than not, but let’s face it….the books we write will never be like the stories they have on the Farm unless we live in a homebirthing culture. Yet we keep on slogging, praying that each great birth we attend contributes to a healing of this culture and the slow, slow swinging of the pendulum. For now, I seek to make hospital birth, which is the norm no matter what I have to say about it, as humane and as beautiful as I possibly can. If I didn’t see great success with that much of the time, I couldn’t continue doing this work. I would be walking around permanently wounded. So doulas, especially newer doulas who have been having their eyes opened to the reality of hospital birth despite their hopes and best intentions, though it sometimes seems overwhelming and impossible, don’t give up. We are making a difference.
Lesley Everest
www.MotherWit.ca
by MotherWit | Mar 12, 2011 | Uncategorized
It is official! MotherWit is hitting the East Coast of Canada this summer. Join the Doula Ceilidh from July 24th to July 29th as we get down to the nitty gritty, the earthy crunchy, and even the airy fairy of the science and art of being a doula.
This full six day/3 evening birth doula training intensive will take place at the beautiful WindHorse Farm in New Germany, Nova Scotia (windhorsefarm.org), which is about a 90 minute drive from Halifax and 30 minute drive from Lunenburg (home of the Bluenose). We are renting the Sunshine/Carriage House which will hold our hostess (Katrina of Cape Breton) and 15 live-in students (though our training will not be limited to 15 for those who wish not to stay in the house).
Our unique intensive approach is geared to eating, breathing, and sleeping birth. Our training last summer in Morin Heights, Quebec among the beautiful scenery of the Laurentian hills and living in close quarters for nearly a week created a life changing experience for many of the women who attended. In this tradition, we bring our training to you doula sisters and doula wanna be’s out east.
This course in holistic birth doula work is great for those who desire to serve their community as doulas, for those wanting to go on to study midwifery or nursing, for those wishing to expand their knowledge of tending to women in their childbearing year, or for more experienced doulas who wish to deepen their knowledge and wisdom. There are no prerequisites except a desire to nurture, educate, and support families during this special time in their lives. A doula has the potential to bring profound healing to a wounded birth culture with each family she serves. Evidence supports the fact that the presence of a doula in the birthing room reduces the risk of unnecessary interventions (as well as potentially mitigating the risks of those that could become necessary), and this training will show you how to do it.
We will talk about the tools women have used to help promote balance and healing since women have been birthing, as well as explore in detail how to create and hold the space conducive to normal, triumphant childbirth in different settings, as well learn how to support those having more challenging or even traumatic births. Learning how to deal with difficult situations and how to tend to ourselves as doulas is also emphasised in this course. Nestled within the shelter of Windhorse Farm and supported by the magical beauty of Nova Scotia, join us on this journey.
Women from Prince Edward Island, New Brunswick, and Newfoundland, it would be such an honour to have you. We realize doula training may be difficult to find in your areas, so this would be a perfect opportunity to learn to start generating crucial change to the birth culture in your town. It really doesn’t matter where you’re from. If you’ve always wanted to visit Nova Scotia, here’s a great reason to do it.
Join me and my teaching assistant Sesch Wren for a week you’ll never forget!
Details will be put up on http://www.motherwit.ca/ soon.
For you ladies farther out West, you are not forgotten! The amazing Tracey from Birth Source Inc. (http://www.birthsource.ca/) and I have been having some very interesting chats about bringing this new approach to doula training to Edmonton. We are also discussing bringing the MotherWit Doula Mentor Training to Edmonton as well, which is intended for experienced doulas (certification not necessary) who have a strong desire to reignite the ancient approach of taking apprentices, which is ultimately the very best way to learn how to be a doula: from other experienced doulas. No dates have been set yet and we’re still in the planning phase, but just so you know we’re thinking of you.
And for you ladies across the pond, the sweet Rebecca Wright (http://www.durhamdoulas.com/) and I have been doing some planning of a birth doula training intensive for UK doula sisters, as well as the mentorship workshop for experienced doulas. Irish, Scottish, Welsh and English doulas/doula wanna be’s, keep checking back for more information as our plans develop.
If you’re from anywhere else and are wishing so much you could join us but just can’t because of distance, consider hosting us. We LOVE to travel.
by MotherWit | Feb 11, 2011 | Uncategorized
When I meet people who are interested in working with me as a doula or childbirth educator, one of their burning questions is: “Are you going to teach me about positions to use in labour to make me more comfortable?”
While I may do the briefest of overviews to show what many women enjoy doing positionally with their contractions, asking them and their partners to try them out so they can feel comfortable knowing what they are doing is totally normal once they’re in labour, positions for comfort is actually something I don’t focus on a lot. I tend to find most women know what to do in normal, ummedicated, physiological labour to make their contractions more efficient and comfortable. If we provide fancy charts of positions that are helpful to birthing women, it assumes they will be using their intellect during labour to mentally bring up the image of the “menu” of positions (or check their notes while actually in labour), and select which might work for their particular scenario. While this may help in early labour (or not, as I tend to recommend the “don’t focus on early labour and find something to distract yourself with” approach rather than the “focus on the early sensations with all kinds of positioning and massage so you’re at a loss as to what to use to help when things really get cooking” approach), the kinds of contractions that have you drifting away on an endorphin cloud to lala land are simply not conducive to the mental gymnastics of cross referencing.
I have actually not seen a labouring woman with back pain NOT lean over or go on her hands and knees to take that desperate pressure off her sacrum. I often see women who are being monitored while lying on a bed rip off the transducers and stand up because they simply cannot lie there any longer. They can’t tell you why, they just know they cannot bear that position anymore. Their bodies are guiding them intuitively, their babies whispering from the inside, “Mama, I need some more space…move this way.”
I have had women yell in transition, “Tell me what to do! What do I do?!” and I’ll make a suggestion, but inevitably they do what they want. I remember a woman asking her midwife what to do and the midwife suggested she sit on the toilet. It’s a great suggestion…the opening of the legs, the safety of the toilet, the squatting position putting pressure of the baby’s head on the stretchy cervix, helping it to open perhaps more quickly. There’s no need to explain all of that to the labouring mom , as it’s too much information for her to process. All she wants is some direction on which to anchor her hopes that this will all be over soon. Despite the midwife’s simple suggestion, the mom just stood over the toilet. All she wanted to do was stand, so finally after being asked several times what she should do, the midwife validated that clearly what this woman wanted to do was stand, and to trust that. When she started grasping and pulling down on the shower rod, we guided her out of the bath (where she was standing) so she could grab onto the trapeze bar provided for that purpose. She birthed beautifully hanging from the bar. That would have happened whether she had been educated about positions in advance or not.
Labouring mothers often do some strange things to comfort themselves in labour, and it’s all good. I’ve seen women lie down on the bare hospital floor because it felt cool, stand up on a chair because the floor felt too hard, or walk like an elephant on all fours swaying to and fro with their heads. All a mom needs to know is that if it feels good, she can go for it.
Where positioning education comes in very handy is when the mother has an epidural. Because many of her body instincts are numbed by the medications and positioning of the baby can become misaligned with the pelvic structure, suggestions of position changes help a lot. And because the mother is capable with the reduction or absense of pain and endorphins to draw upon her intellectual capacities, a check list she’s learned in advance of positions to increase labour’s efficacy can be extremely useful if she doesn’t have anyone around to guide her with this.
When labour is NOT going normally and clearly the baby needs to do some shifting to create a better fit with Mom’s pelvis, positioning can be extremely helpful. I had a mom once whose back was so sore and stiff from a long hard labour that she couldn’t sit down. She wanted to, but the aching prevented her from acting out her intuition. Her husband and I tried to guide her to sit on the toilet, but she just couldn’t bend her knees. Her poor back was raw from all our rubbing. Her poor bum muscles were so tight from all the pain, so my instinct was to grab them and shake them out. I did this for a good minute, just jiggling those bum cheeks. We were all giggling a little. Finally the mom sat down, and things got moving immediately. She ran to the bed, got on all fours, and was found to be fully dilated. Again, we could teach all that in childbirth ed, but really, when in the throes of labour, without some skilled direction, she and her stressed out partner probably won’t think about all the possibilities or receive support. This is why good childbirth education AND good doula support create better outcomes than just education.
Positions for rest are something I like to talk about. Sometimes moms get really tired, but cannot stay in a position during contractions that they really like between them. So knowing how to rest and contract in one position for a bit while she regains her energy is useful. I like using a yoga ball and edge of a bed or counter to lean over on for resting and contracting, or hanging out in the bath. It’s important that the skill of how to rest and chill out in labour is as important as riding the waves of contractions.
Another area in which discussiong positions is useful is when it comes to the second stage of labour. I love to watch people’s faces as I demonstrate what a normal labouring woman often loves to do when that fetal ejection reflex kicks in…butt juts outward, arms reach up to grasp, torso leans way forward. I gently and slowly tip myself backwards without moving any limbs, just letting my hands grasp my knees, and it really hits home how, when you adopt the stranded beetle position, a woman is asked to do the EXACT opposite in most OB assisted births of what Nature asks, effectively mobilizing the sacrum (which dearly wants to be able to stretch and yield to the babe’s extending head), perhaps necessitating circus style pushing to compensate for the smaller space created in the pelvis, and potentially wreaking all kinds of nasty havoc. Telling women that there is a good possibility of their not feeling great being on their backs while pushing (as many don’t know this is not the real “way” the body likes to deliver babies), and that their instincts to do otherwise are spot on regardless of what they’re directed, helps them to know they’re not “bad” patients or somehow abnormal. And it’s also helpful for them to know that there is no black and white, and that if they do happen to feel good on their backs, then this is absolutely fine too. Just because it may not be an ideal position for some, it may certainly be for others. I have seen women whose babies are exiting with great speed (myself included) throw themselves spontaneously on their backs. Perhaps this is how we are intuively guided to slow things down a little.
It is important to remember that birth is not intellectual from the birthing woman’s point of view. The more charts and diagrams a woman has to look at and follow, the more she gets caught in wondering, “okay at what point do I do this, what sensation necessitates this position, etc.” This is exactly where we do NOT want labouring ladies to be…in their heads worrying about what is “right”. If they seem as happy as they can be in super active labour and things are going well, then it’s right. The most useful tools in childbirth education are not the fancy tricks that are learned involving balls and positions, but the practice of relaxation, release of tension through whatever means the mother prefers, and the ability to stay with the sensations confidently as opposed to reacting to them with fear.
