by MotherWit | Feb 8, 2011 | Uncategorized
Scary things can happen in birth sometimes. It’s not something we like to think about, but the fear of emergencies in birth is something that lurks in the corners of the minds of pregnant women and their caregivers alike.
As doulas, occasionally we are front row centre witnesses for someones trauma. It can feel powerless watching those scary things unfold. We are often grasping at straws in our minds wondering, “What do I do? How can I help fix this?” Well, sometimes we can’t. As much as we try to prevent birth trauma by guiding people to empowered choices and as much as we hate for bad things to happen to the couples in our care, the unexpected can occur. We can end up feeling very powerless when an emergency takes place, and it’s crucial to know how to anchor ourselves in the eye of the hurricane so as to create the optimal space for healing to begin as soon as possible.
While trauma is occurring:
1) Acknowledge it. We need to look those parents deeply in the eyes, take a breath, and in our own gentle, loving way say, “Yeah. Here we are. That scary place nobody ever wants to go. Breathe, and hold on.”. Trying to “make it pretty” when the proverbial poop is hitting the fan, minimizies the experience and only leads to dissociation.
2) Stay present. Breaking down emotionally, getting caught up in those bubbles of fear and drama, and freezing up is not an option. You cannot “check out”. You need to open your heart up, waaaayyy up, stay anchored within the chaos, and stay there strongly with your clients. Be totally present, surrounding them with as much love and calm coming out of that open heart space as possible. It may sound flaky, but the emotional tone we set can have the power to keep others calm. As doulas are very much “space holders”, what we energetically broadcast into the room can influence how the parents and caregivers respond to the trauma.
3) Reassure when possible. If a woman has to go through a tough obstetric procedure, while we can’t make it rosy, we can definitely let her and her partner know all the positive aspects of what is happening, like “You are doing GREAT!”, “We can see your baby now, hang on!”, “This is the hardest part and it’s almost finished.” If Baby is an issue, repeating the positive things you hear the caregivers saying can be helpful to parents, such as, “They say your baby’s heart rate sounds great.” or “Her breathing has improved a lot in the last minute.” A blue floppy baby is all a parent will see, and if it is appropriate, letting them know the good stuff that is going on with their newborn while the caregivers are busy focusing on their tiny patient can help promote calm. Often, parents will not receive this information, and their terror of the unknown could otherwise exacerbate their sense of trauma surrounding the memory of their child’s first moments of life. Being informed and reassured whenever possible is comforting to parents. The look on the faces of new parents when nobody is actually telling them the baby is breathing with a good heart rate is enough to ensure you as a doula are on top of this.
4) Be loving. Touch the mom, speak to her lovingly, stroke her hair, coo to her. Be loving to her partner. This helps to promote oxytocin and reduce too much adrenaline response. Doing whatever you can to keep that mother/baby hormonal connection intact, even when the baby needs to make a fast birth exit or has just had a difficult passage and is not able to be in the room with her, may help improve her future memory of her birth experience.
5) Trust. Give caregivers ample room and support in their important job of dealing with a medical emergency. Trusting doesn’t create the outcome we want, but staying connected to the trust whenever possible that everyone is doing their best, promotes calm, often helping the best care come about. As doulas, our spiritual beliefs are definitely something to draw from at this time, if we are so inclined. The idea of trusting that as we hold the space for our clients and everyone else in the room, all of us are also being held by a loving source, even if what’s happening is something we can’t make sense of, is something many doulas and caregivers seek comfort in. Knowing deeply we have no ultimate control and that our power lies simply in doing the tasks required, being present, and living this moment as fully as possible, no matter what, is often what helps us all to heal more completely when the emergency is over.
Once trauma has occurred and everyone is left picking up the pieces:
6) Beware of magical thinking. I had a sweet, lovely student end up attending several dramatic C-sections for her first mentored births. After the third, she broke down in sobs, asking, “Is it ME?” The doctor present was loving but firm and gave her a great reality check: “Ah, Sweetheart, you feel like you’ve earned the black crow award because all you’ve been present for so far is emergencies. We can all feel like this. Really, though, you’re not THAT powerful that you can bring on bad outcomes just by your presence.” This is a wise and straight to the point wake up call on those days we are stuck in the past traumatic experience, trying to envision what a different outcome might have been had we heroically jumped in to do the impossible to spare a woman from turmoil. Know what to own, know what to let go of as magical thinking. Help your client avoid falling into this trap too.
7) Don’t entertain the “why” and “what if” too much beyond getting to the basic physical reasons something may have happened. Spending hours conjecturing “why” is not healthy, and with doulas/caregivers sometimes even arrogant as we try to throw out many hypotheses that will usually only ever remain hypotheses. It soothes our egos to have a tangible reason for those unexplained traumas, but healing isn’t about soothing our egos. Sometimes things are just mysteries, and what’s done is done. Sure, when there is evidence for something, it can feel good to know actions were completely justified. However, often there are many pieces of the puzzle missing, and will always be missing. An amazingly wise Abenaki Grandmother told me once, “Every time you ask why, Spirit takes a step back. Who says you get to be privy to why something happens the way it does? Instead, ask, ‘What is it I can learn from this experience? Spirit will take a step forward.'”
Many clients after trauma will ask if you think the outcome could have been different had they done something else, for example, let’s say, birthed vaginally had they avoided the epidural. You cannot possibly answer this question. Gently point out that wallowing in the whys and what ifs are fodder for self flagellation, and not healing. Embracing the experience for whatever it was, good or bad, making meaning of it, and living fully is usually a better choice for healing. This may only come about after a long period of grieving.
8) Debrief with your clients about their experience. Let them pour out their pain without trying to pretty the experience up for them. Don’t join the ranks who say, “Well, at least you have a healthy baby.” (if the baby is indeed healthy). Women need to feel “allowed” to grieve the loss of the experience they wanted. It’s not selfish to have hoped for a lovely birth. It is heartbreaking to have suffered trauma. Grief is totally appropriate. My dear friend says when something has gone badly, “Dude, that sucks.” She says it with absolute compassion, and there is comfort in knowing that someone acknowledges that something plainly sucked as opposed to having someone be chirpy and sunshiny when the real emotional landscape is so obviously grey. We want people we care about so much to feel better, but it’s not always possible for a while. Sparing someone from authentic feelings and creating dissociation by interjecting niceties is more about our being uncomfortable with their feelings, and it’s the same pattern that contributes to such high epidural rates, “Oh, poor dear, you’re suffering. I can’t stand to see you in pain. Let’s just make it go away.”
When the whole thing is talked out and there is more emotional space for perspective, connect them to where they were amazing and graceful in dealing with such challenging circumstances. It’s not the same as trying to make it pretty. It’s honouring the person’s role in authentic and powerful living. They may have felt totally “weak” because they cried and couldn’t “get on top” of things. Crying and feeling scared is emphatically NOT weakness. Just as the icon of the Zen woman breathing easily and painlessly through her contractions is not an appropriate image of birthing, neither is the stoic stiff upper lip image for someone who is softer and more sensitive.
Deeply honour how a couple moves through the unique emotional terrain of their unique births.
9) Provide resources. If couples need to seek more counseling about birth trauma or reactions of anxiety and/or depression, knowing which professional avenues to send them down is important. Be very aware of your limitations. Doulas are not therapists, and owning all of your client’s emotional process is not appropriate, potentially blocking their healing by not sending them to the proper resources. You can always be available for support, but support doesn’t mean owning their healing.
10) Doula heal your Self. When you have been traumatized, it is your mandate to deal with it. You cannot bring past trauma to the next birth and be fully present for the clients in your care. Doulas can and most certainly do experience Post Tramatic Stress Syndrome, whether it be from a true birth emergency to witnessing violently harmful and disrespectful behaviour towards a client. Whatever the reason, it is our responsibility to take the time we need to heal. Write it out. Connect with your own spiritual practices. CALL YOUR SISTERS! A community of doulas is the best way to help each other heal. I’m all about doula-ing the doula and without the support I receive from my community, I would most likely be a gibbering mess today. Reach out, talk it out, and embrace the incredible richness of this life of birth attending. Connect, ultimately, with your Love, as this is what grows when we remain present and seek to heal our own wounds. This Love can serve as a light to those healing their own traumas.
by MotherWit | Feb 7, 2011 | Uncategorized
I am so excited to be welcoming the new wave of doula students who will be embarking upon this journey with me on February 17th, 18th, 19th, and 20th, and March 17th, 18th, 19th, and 20th.
This is a bit of a new format. Our last training was in the beautiful hills of Morin Heights where we connected to Nature and lived/breathed/ate/slept Birth for six incredibly intense days and nights. This format suits those who cannot leave the city for that long, and who like to take things a little slower, having a month’s break to process learnings before moving on to studying how to hold the more challenging aspects of birth and hospital environment. I will still do intensives for any group of doulas who wish anywhere in the world, but the Montreal training will be a more leisurely format this year.
Apprenticeships are wrapping up from the last training…we have established regular case study/doula support nights, the students are well connected, providing support and guidance for each other, creating and nourishing the community of birth healers I have been wishing to see for years. Many are almost finished their training requirements and soon we will have more well prepared doulas out in the world who have been guided and mentored. This is the core of doula work: woman to woman support, birth attendants healing themselves, an ability for doulas to not only know how to help on a factual level, but to intuit, guide, and offer wisdom. I am so deeply proud of my trainees, as they slowly make their transition from apprentices to colleagues, adding their voices, their stories, and their skills to those of the many visionaries we need to bring this birth culture, which has spiraled outwards in its insanity, back to where it belongs…into the hands of the family….at its very root a transitional journey ripe with potential for healing. It is an honour to embrace these women as sisters.
I open my arms to all of you, new MotherWittie novices, and am so glad to have the opportunity to teach you some of the things I know. We are going to have fun, you are going to experience challenge, and you will find healing and growth. Thanks so much for joining us, and I’ll see you in a few days!
Lesley
by MotherWit | Jan 12, 2011 | Uncategorized
“Doula” is not yet a common household word, though the importance of the role of a doula in modern maternity care is well documented in many studies. For those of you new to the concept, a doula is a woman who supports pregnant, birthing, and postpartum women and their families. The word is derived from the ancient Greek word for “slave” (I know, strange, right?), but has come to mean “in the service of women” in modern times. A doula supports women in their childbearing year by providing information about what she’s going through and the choices she will face as pregnancy, birth, and mothering unfolds, offers comfort measures to ease the bumps along the journey, as well as reassures with constant emotional support.
If the mother has a partner, he or she also benefits from a doula’s care, as the doula’s support extends to them as well, ensuring they are well informed, prepared, and relieved of the stressful feelings many duties required of birth partners evoke. Many things concern the birth partner, such as knowing whether what the mother is experiencing is normal or not (if someone has never seen birth before, it may not be obvious that shaking, vomiting, and loud vocalizations are all very typical things labouring ladies do), having to press hospital staff for clarification surrounding medical interventions in birth, knowing what best techniques and methods to use to help the mother cope with the strong sensations and emotions that come up in birth, knowing how to deal with sore nipples during breastfeeding, etc….the list is vast. By being free of the burden of anxiety of having to know all the details of birth and how to advocate for the mother and help her deal with the challenging task of birth, not to mention at the same time being an emotionally invested, possibly nervous partner and co-parent, the partner can be fully present for the mother, holding her, encouraging her, and providing the intimate connection which gives so many women the strength they need to get the hard job of birthing done.
A question that commonly comes up is, “Is a doula the same as a midwife?” The answer to that is “no”. Midwives, while also usually extremely supportive to the couple in their childbearing year, also usually have the responsibility of the mother’s clinical care, meaning the midwife is the one who assesses and monitors the mother and baby’s health throughout pregnancy and birth as well as the weeks following birth. She is usually a primary caregiver, and depending upon the laws of the country, province,state or county the midwife lives in, she “delivers” babies in a home, hospital, or birthing centre setting.
A doula’s care is not clinical. Some doulas have midwifery skills, and if this is the case, they often, if where they live allows, work as “monitrices”, meaning they provide the support of a doula, but monitor the mother’s and baby’s health at home until she feels it is time to move to the hospital for a doctor or midwife to take over clinical responsibility of the birth while she stays to support the couple. Because a doula is not responsible for a woman’s or baby’s health status, she is free to provide that information, comfort, and support the couple wants. That nuance was really brought home to me during the birth of my first child. My midwife arrived at my home when I felt like labour was good and strong. She listened to the baby’s heart through my belly and examined my cervix. She said, “Everything is good. I’m going to go take my sleeping bag and have a nap in the other room so I can be fresh when the baby is born. My assistant will stay with you.” I didn’t know the assistant well, though she was very nice. She was not, however, particularly skilled at providing comfort or emotional support, and didn’t really address my inexperienced anxiety at having dilated from 3 to only 4 centimetres in 18 hours of labour. It was my doula and my husband who kept me grounded and provided me with immense comfort, like massage for my sore back, whispered sweet nothings, and a real sense of emotional safety. Not that a midwife can’t or doesn’t do that very same thing, it’s just that in my case, she was tired from having attended a lot of births, and was doing the responsible thing by ensuring she was fresh and awake when I gave birth so she could better use her clinical skills if they became necessary. When primary caregivers and doulas work together, the couple often feel they are getting the best of care, meaning a good clinical safety net should it become necessary, as well as continual supportive care.
I have been a doula in Montreal for over 17 years now. I have often been asked why I don’t go on to become a midwife or a doctor. For one, I enjoy being “just” a doula. I am personally not interested in being responsible for important health decisions should they arise. I have much respect for those who are, and I prefer to let them do their thing while I remain continually emotionally present for pregnant, birthing, and postpartum women. If things go unexpectedly in birth, then clinical care is the priority of the primary caregiver, whereas the doula takes those scared parents-to-be by the hand, looks deeply into their eyes, weaves a web of calm around them and says, “Okay. Here we are..yes, in that very place you were scared to be. Breathe and stay.” If things go normally, as they usually do, we simply remain available for what the parents need for comfort.
My favourite thing about being a doula is being a keeper of precious memories for parents, of moments of their love and brilliance told to them later on in our postpartum follow up visits. To witness a new father moments after birth as he anoints his baby with his tears of awe, or to hear those quiet, holy words of love whispered to a newborn by his enraptured mother is to hold the most beautiful and subtle threads of the tapestry of the story of this family’s beginning, threads that are lovingly handed to them in the moments the parents are swept away on the roller coaster ride of the postpartum period. These bits of story connect them to their strength, serving as reminders that all of this experience, even the hard parts, is about love. The healing potential in these juicy bits of story could be so easily missed if we as doulas had to put our attention to the clinical details. We walk the halls with our couples while they labour, sit by them while they rest in the bathtub, just listening…with our ears, with our hearts, always striving to find the balance between being and doing.
As we are story keepers, so are we keepers of the gate between fear and confidence, distress and courage, panic and calm, empowerment and victimization. While we do not own the birth our clients experience, nor attempt to control birth or birth’s caregivers, our belief in birth as a sacred journey, no matter how it unfolds, very much holds the potential to influence the process. Doulas strive at births to be our most grounded in the knowledge we have as well as open to the realms of intuition, which we look to when we need to know the best way to buffer a harsh environment, or to sooth away the ripples caused by an unconscious yet hurtful remark, so things that could otherwise potentially be perceived as trauma do not get a chance to anchor into the labouring woman’s perception and be carried into motherhood with her. It is not always possible, but we try our best.
As a young doula I wanted to help women have natural births, no matter what. I felt like the epidural and I were in competition. I was easily wounded by the often shocking hospital environment, and felt like if a woman received an intervention, I had failed. It took time and experience to know on a cellular level that my job was not to rue every little intervention. I don’t own another woman’s birth. She is responsible for her choices. If she decides she must give birth in a hospital to feel safe, she will be subject to the environment. I do my best to buffer the harshness of the hospital environment and empower her as best I can so she is able to make choices suitable to her. If she chooses induction because she and her doctor feel this is best, it is not my business or my right to dissuade her. I ensure she has the best information I can give her at her fingertips with which to make an informed choice, and when she chooses, I support. Yeah, that ride may potentially prove to be really bumpy as all those risks she was hoping to avoid with induction become reality in her experience. And so it is. This is her story, her learning, and her own grappling with the tension that lies between trust in her body and fear of not doing the right thing for her baby. I have learned that my job is to support not always what I wish would be for someone, but what exists in the now.
I know many have contempt for doulas…the Medical Establishment (and I refer to an entity, not to individuals, whom I find are most often caring and have the best interest of the mother and baby at heart) for our illuminating the often gross shortcomings in the sometimes unconscious and unkind policies that are not at all supportive of a labouring woman, her baby, and her partner. There are as well those who think doulas are sell outs by trying to help women have more humane birth experiences within the hospital system, standing idly by as we meekly “allow” our clients to be brutalized. Again, I support what is, not just what I wish would be. Sure, I’d love us all to claim responsibility for our own births, birth at home humanely and lovingly, our experiences undisturbed, our babies born into optimal bonding environments with bodies, minds, and spirits intact. I am blessed to have had that experience three out of four times, and I want that as much for everyone as the next guy does. But if about 98% of women in North America are giving birth in the hospital, most with medical care, because they feel safe there or they feel it’s the only option they have, this sense of safety and lack of options a product of a culture that is terrified of birth and death, do these women not need an incredible amount of support to have birth experiences they can look back on with a sense of power? I do not believe my trying to help a lady have a decent birth in spite of the hospital environment will make women go, “Oh, okay, it’s all good, then,” and lessen the minuscule percentages of those who choose home birth. I alone am not going to get those 98% to change their minds, regardless of all the stats which tend to support the idea that home birth is as safe or in many cases even safer than hospital birth. Many people may understand that their fears are overblown on an intellectual level. But the collective fear is so big, people still pack their bags and birth in the hospital with obstetricians anyway. And if that’s where they feel safe, and that’s where they want to be, that’s where you’ll find me. I’m not there to judge what makes someone feel safe. I’m just there to help when I can. And believe me, when things go awry, I’m very grateful for obstetricians and technology. I am not against hospital births or doctors or nurses at all. What I am challenged by are many of the policies and protocols which detract from the normalcy of most births. This is where change must happen, and I’m hoping it will grow from more positive hospital birth outcomes, which the presence of a doula is shown to increase.
Isn’t every birth a woman looks upon with love and good memories a triumph, even if it isn’t filled with the potential for “perfection” (meaning perfectly undisturbed, perfect environment, perfect bonding, etc.)? Isn’t it good to have a few more women come out of the hospital feeling like strong and powerful mothers? Of course it happens that sometimes when a woman looks at her birth with fondness I am knotted up inside at the things she maybe didn’t know looked heinous to me. But who am I to tear apart her birth experience because my vision of great birth isn’t the same as hers? I WANT her happiness, and am thrilled for her triumph, and I have learned not to be attached to my version of “perfection” in birth. If something was really awful and she was unconscious of it at the time because she was all hopped up on her love and ecstasy hormones, adoring the nurse who was maybe actually quite impatient with her, and feeling bonded with the doctor who brought up emergency cases with the resident in front her of while she birthed, it will come up. It will sit in the back of her memory until it is ready to burble up to the surface for illumination. And when it does, I usually get a call, and then we process it. Often there are delayed reactions. If it never happens, fine…it is not for me to say what “should” traumatize someone.. but if it does, many of these women go on to choose different routes for their next birth experiences. There are many roads to empowerment.
My path as a doula has morphed from just wanting to see nice births to really trying to help improve maternity care in hospitals. Midwives are doing a great job tending to those families who feel happy birthing outside of the hospital, and God love ’em. There is a big movement right now that is shedding light on the some of the potential pitfalls of hospital birth and illuminating the beauty of homebirth and potential for the amazing strength women possess. Women are taking their experiences and using them for others to learn and gain courage from. One of my favourite examples is the scene in the The Business of Being Born where Ricki Lake gives birth in her bathtub. She is naked, hurting, and vulnerable, yet at the same time in her fullest power. She allows us to witness her bringing her child joyfully into the world, a generous and precious gift to our lost birth culture, an invitation to those who have maybe never thought about birth beyond how soon they can get an epidural, or had perhaps not even had an idea that homebirth was an option they could pursue for themselves. This is potent medicine.
We have had grassroots homebirth movements for some time, but to now reach out to the mainstream, to not just preach to the converted but to begin little by little to shift the collective consciousness from overwhelming fear and contempt of anything that questions what Medicine tells us to, to “I’m still afraid but somewhat curious…maybe some change is needed” is crucial. While the rising Cesarean rate and crazy induction and routine epidural epidemic continue to wreak havoc in North American hospital birth, this slight shift gives us a glimmer of hope that we have to nurture and help grow…hope that our birth wounds can begin to heal…slowly, little by little, decade by decade. Along with the work people do to raise awareness, consumers of medical care must also become aware of their responsibility in birth. As long as we put all the power in a doctor’s hands to get our babies out, the pressure on them is enormous, and their fear of not doing everything possible to meet these expectations and maybe even the fear of litigation makes medical maternity care often very aggressive indeed. We cannot simply lay blame on Medicine…we have to look at areas where we may have abdicated our own responsibilities as well.
Doulas, with their belief that birth is usually normal and healthy, go into the hospital with a couple and try to keep them, within that environment of “what if” and “risk” and “danger”, connected to their intuitive knowledge, their practical wisdom: their motherwit. I choose to do this as my part. This is my small contribution to what I hope is healing. One mother, father, and baby at a time.
The doula training I provide reflects this impetus to create healing within the system that often perpetrates great wounds (while honouring the many blessings it can also provide). Many doulas have contacted me over the years, feeling woefully unprepared for doing this crazy job within an environment that can be resistant and sometimes cruel. While I feel that my work as a doula has changed its shape over the years, I feel that training needs have changed too. I think we need a paradigm shift in what a good doula training constitutes. I do not believe a woman can take a 2 or 3 day training and do this job with enough skill and enough tools with which to protect herself emotionally. This approach doesn’t gel well with this profession. This is why I believe wholeheartedly in the apprenticeship model of learning, and strive to promote it as a new standard of doula training. While many trainings are excellent given the time they’re done in in terms of learning hands on labour support techniques and how to deal with challenges, a lot of the students are very focused on papers and credentials and sometimes arbitrary limitations that are as fear based as hospitals are, and I have not found those things to confer good doula skills. Yes, it is up to the doula to continue her education and be self motivated to study, but this kind of learning does not necessarily help develop wisdom.
I believe strongly in the value of having an experienced birth attendant doula the doula (yes, I am using “doula” as a verb) as she embarks upon this journey of birth healing, helping her build her skills, recognizing her vulnerabilities, being involved in her education and development. I like to bring her into the hospital with me so she can observe, without pressure, as birth unfolds, no matter how it is. It is good for my students to have to shift gears and prepare for the planned C-section they were hoping our client could avoid and bounce creative ideas of how to give the best support off someone experienced. It is good for them to call me in a shaky voice telling me they’re not doing well emotionally because the birth they are at is really hard, the woman is losing it, barfing uncontrollably, and the novice doesn’t know what to do to make her feel better, learning the lesson that sometimes you can’t and you just have to keep trying and be present. It is good to get a call in the wee hours from a new doula who has witnessed something traumatic saying, “I am so angry and I don’t know how to go back in there and do a good job” and have someone who has been through it talk her off the ledge and bring her back to her centre. It is good for them to miss a birth because it was so fast near the end and know clients were so happy because it went well and are grateful to her because they used all that good prenatal guidance they were given, and good to be able to call and ask, “they’re not just trying to make me feel better, right?” It is good to have gatherings so the apprentices can build community with each other as well, and can vent and cry, laugh and muse, ask questions and come up with their own answers with encouragement. And it is good for me to learn from them too.
As I continue to support women in birth, and hopefully will continue to do for decades to come, I continually develop my approach to training new doulas. This is important work. We are striving to shift the pendulum, adding our voices and skills to those who are also working hard to illuminate, educate, and empower people about what birth has the potential to be. I am excited that my birth and postpartum doula trainings, as well as MotherWit doula mentor training workshop is sparking interest in student and experienced doulas around the globe who are realizing the potential they have to be a wealth of resource and support for parents to be and new doulas. Though I don’t know if I’ll see radical changes for the better in hospital maternity care in my life time (though being asked to give doula workshops to nurses and even medical residents has been a really pleasant surprise), I will remain steadfastly hopeful that doulas are making a difference not just to the individual families they serve, but to our culture as a whole.
This is my path, and I’m sticking to it.
by MotherWit | Jan 4, 2011 | Uncategorized
CBC News came to the MotherWit Doula Centre a few weeks ago to an interview with some doulas and clients. It’s a very short, but very nice overview of how doulas are becoming more visible in the public eye.
If you go to 23 minutes and 40 seconds into the broadcast, you can see some of what we’re up to here in Montreal. Enjoy!
by MotherWit | Dec 28, 2010 | Uncategorized
I just got home from an absolutely gorgeous birth of a nice big boy. This is most likely my last birth before the new year, though anything is possible. As I have time to do so now, I’ll share how things went this year.
Before getting to the birth stats, let me just say this has been a HUGE year for me, full of growth. Though I have been a doula for quite some time, MotherWit is just over a year old. In this year I created and we launched our very successful Birth Essentials: A Course in Childbirth Empowerment prenatal classes. I taught my birth doula training in intensive format for the first time with great success. I also taught for the first time a four day postpartum doula training course. Both trainings required many hours of creation and hundreds of pages of doula training manual writing. The work was well worth all the effort, and I am very very pleased with my amazing apprentices and students.
The MotherWit team opened a physical space, something we had been hoping to do for quite some time. In this space we teach our classes, see our clients, do trainings, have mom/baby groups, apprentice meetings, “Meet the Doula” soirees, and will soon be doing infant massage teaching for parents. We have parties, too. I am thrilled with our cozy space.
MotherWit was asked to do 2 informal, in- hospital doula-led workshops…one 8 hour workshop for new nurses, and one 1 hour workshop for family medicine residents. Oh, what fun! This was a very eye opening endeavour, and we learned a lot about where many medical people’s hearts are at…it was all good news. We also learned about how restrictive protocols and policies can be and how they inhibit some of the ways some of these people really wish they could work. There is lots of exciting work to do in these areas to create more satisfactory birth experiences for families who want/need to birth in a hospital. Working together, I truly believe good changes can be made. People often think I’m a PollyAnna and a dimwit for holding onto that hope. But I stand by it. Yes, I am myself a home birther. Yes, I point women who want to take that route to all the resources available whenever it seems they want this option. Yes, I sometimes feel I am being asked to witness train wrecks. Yes, sometimes what happens in hospitals is terribly hurtful and frustrating. But as MOST women are still wanting to birth in the hospital because this is where they feel safest, I feel focusing my energies on ensuring these potentially overly managed births, often the price for this sense of safety, have a lot of input from well informed, well prepared parents. I also feel it is crucial for these women and men to have emotional buffering when necessary. Everyone deserves support in labour, to have their choices honoured, and to feel heard and loved. This is the essence of doula work.
I also went to Madagascar this year! Yes, I am still intending to blog about this experience, but as you can see, work has been crazy! I will get there. It was incredible! The preparation to get this trip underway was no easy feat, and it took a lot of time and energy, again, well worth the effort.
On a personal note, my eldest baby turned 18 and my youngest baby started Kindergarten this year. My sisters came from the UK to visit because one of them got married here in Quebec…a truly lovely wedding. My mom and stepfather had some health challenges that are now, thank Goodness, behind them (ptu ptu ptu). It felt like a real blessing to have Christmas together with everyone in good health. I lost my friend Lhasa to breast cancer early this year. If it taught me anything, it was to seize opportunities and to be very grateful for every day.
I attended 42 births this year and saw 47 babies enter into this world. This is, thank Goodness, 21 births less than I attended last year. My goal had been to attend much less births. While 42 births is still a ton given everything else I’ve been doing, it was technically still a bit of an easier year in terms of birth attending. I am so glad for the MotherWit team who are slowly beginning to take over the volume of births I’m trying to let go of little by little. My goal is to do significantly less this year so I can focus on teaching, as I have been receiving requests from different places to train doulas. I also REALLY want to finish my book. I had hoped it would have been done this year, but not yet.
Many people think doulas have good stats because we attract couples who want natural births. This is so not always the case. As doula work becomes more mainstream, it is not necessarily those who are hoping for a natural birth who seek out our services. Often it’s couples who are savvy of how lost they may become within the hospital system, and just really want an anchor, or to ensure there will be someone there to trust them and give them support when they feel afraid. As I said, everyone deserves support in childbirth, not just those who have the goal of natural childbirth in mind.
The main demographic of my clients are educated middle to upper class couples. They are of varying races, religions, and sexual orientation. While having a large percentage of educated, prosperous couples as clients may sound easy, I assure you this is not often the case. Many of these couples come to birth having been very focused on careers up ’til this point, and are educated about birth via friends (who love to share horror stories), media, and their doctors. The connection they forge with their bodies and their emotional needs as soon to be parents (with our guidance) is often very new. Our way of helping couples prepare for birth is less intellectual and more about encouraging them NOT to trust a clock or a number, but to tune into themselves. It is not easy encouraging women who have spent all their lives in control of things to let go and allow this primal process to unfold organically. They often refer to “those other ladies” who can squat in the fields, not realizing that they are capable of that too. Their doctors also often assume that because they are educated and career oriented that they will be thrilled with the “civilized” way of birth (induction and epidural), so it’s often promoted as a good thing for them. One of my clients was offered a planned Cesarean (not often done in Quebec at all), probably simply because she comes from a very wealthy family, and it was assumed (wrongly) that she would feel too posh to push. Believe me, we have our work cut out for us to help women connect to those fledgling, barely whispered of hopes they hold that maybe they could have births like the women in those documentaries, even if they’re not planning to give birth at home in a kiddie pool but with a high risk obstetrician at a tertiery care hospital because they’re on the long toothed side of 35, and in spite of the fact they are getting most of their childbirth education from a culture who looks to A Baby Story for inspiration. To those of you who really know birth, I know this sounds like an impossible dream. But I am telling you, even though they’re not birthing in pools, they are getting to places they never thought they’d go, and these ladies who are often told by their friends and doctors that they WILL be begging for “their” epidurals (as if there’s one just waiting to scoop up every birthing woman) as soon as the going gets really tough, ARE BIRTHING NATURALLY! With doulas, anyway. Yes, we still see way more epidurals and Cesareans than we otherwise would if most of these women planned to give birth at home, but substantially more than half of my mamas birthed naturally this year.
Out of these 42 births, only 2 this year were planned outside of a hospital (both were planned at a Maison de Naissance, or Birth House for those of you who don’t speak French or Frenglish, which is a free standing birthing clinic run by midwives…no doctors on staff). One lady was transferred from there to the hospital to give birth, and another gave birth so quickly her midwife barely had time to run to her house to catch her baby. All of the rest happened in hospitals. In the downtown Montreal area, hospital birthing women have up to 98% epidural rates, meaning about 2% of first time mothers here birth without epidural. According to nurses, most of those women wanted an epidural, but didn’t get it on time. Midwives do not make up hospital staff here. All of these births were attended by doctors.
I had a higher percentage than usual of Cesarean births this year. So, in total, 7 surgical births: 1 planned for twins because both were breech (the doctor on call said he would attempt to assist with a vaginal birth, but the mother chose otherwise), 1 planned for twins because one twin was definitely showing signs of distress before labour had even begun, 1 mom induced with 41 week twins (after 36 hours of labour, things didn’t progress), 1 singleton birth planned at 37 weeks for vasa previa, 1 attempted singleton VBAC attempting lady had a repeat C-section for fetal distress due to an abrupted placenta (they thought maybe the uterus had ruptured), 1 planned for twins with a pre-ecclamptic mom with a breech first baby, and one long singleton labour that ended with fetal distress and an emergency Cesarean. All babies were born healthy, or became healthy quickly after birth. This is just shy of a 17 per cent Csection rate, which is the WORST I’ve ever had. As you can see, the majority of these surgical births involved twins. There is SO much work to be done to support twin moms, who are subject to a crazy amount of intervention.
8 of my ladies had epidurals (the ladies who had Csections only had epidurals at the very end of labour because they knew they were going to have surgery, or were planned, so I don’t count them in this stat). 3 were for long, hard posterior labours, 2 were for Cervidil/Pit induced labours, one lady got one at 8cm after her Cervix hadn’t changed after 1.5 hours with transition contractions…wasn’t attached to natural birth, , and two wanted them when labour started getting really tough because they had both had traumatic birth experiences before and were terrified of experiencing that level of pain for a long time again. They felt it was what they needed to feel safe. Epidural rate, 19%
27 of my clients experienced natural birth. Some were “augmented” because of waters being broken for a long time before labour starting, but they gave birth without epidural or IV narcotics.
Out of these natural births 11 were first time moms (one mom of twins in there), 3 were VBACS, and the rest (13) were subsequent vaginal births, most second and a couple of third babies. 64% natural births.
So, folks, that’s this doula’s year in review. I cannot thank those enough who had me at their births, and to all those who have helped and supported MotherWit get off the ground. You are all appreciated.
I will leave you with a nice story. I encountered a lovely resident at the hospital today who told me she had been one of the residents to attend the workshop I gave earlier this year. She told me this workshop had really touched her, and that it had been exciting and eye opening. After my client gave birth with her usual beautiful grace, on her hands and knees with her husband helping, and she and her husband and baby had had some time to bond and bask in the glory of their experience for a while, the resident came up to them and said with her eyes shining, “Thank you so much for the honour of sharing in such a special time in your life.” The message I really tried to give to the residents was to remember this…that no matter how many births they attend, no matter how interesting of a “case” it may be, these patients of theirs are bringing life into the world, and that it is sacred and special. I emphasized that if those patients will remember anything about the people who were involved with their births, it will be how honouring their caregivers were of them. It was really moving to see this resident not only act as if were not just an ordinary part of her day, but to express the sacredness of their experience with her gratitude. May this trend continue….
Happy New Year!
by MotherWit | Dec 14, 2010 | Uncategorized
Occasionally I will have a client who finds out that when she must have a planned Cesarean, she feels she no longer wants doula services, or wants extra postpartum care instead. If this is planned in advance and all are on board, this is fine. Doulas are flexible, and usually don’t mind doing some extra postpartum visits instead, or a friendly termination of services if this is appropriate.
I have heard a few doulas tell me, however, that their clients decided at the last minute they felt a doula at their Cesarean birth was pointless, and demanded other services that were not really within the scope of the birth doula’s work, like night nanny-ing or older child care, in order for the doula to earn the fee. If this is something the doula is really happy with, whatever a client and doula want to do is their business. I feel, however, as a reasonably experienced doula, that contracts are essential to establishing clear boundares. I know they can feel uncomfortable to a doula who is so willing to give everything and bend over backwards to serve all the desires of her client. Doulas serve. This is our essential definition. And because birth is so incredibly unpredictable and changeable, flexibility is part of our natures. But boundaries are important. Doulas need to honour their worth and refrain from feeling badly for taking pay because, for example, a birth went very quickly, or from allowing their family income to take a huge financial hit because they weren’t comfortable standing up for themselves. This can cause resentfulness and burnout. Contracts make things clear. They are important for doulas, especially for newer doulas who are scared of making a client uncomfortable.
If a client signs on for a birth and has agreed to the listed things in the contract such as “if you choose not to have your doula after your prenatal meetings, you are still responsible for the remainder of the fee”, this fee is still owed. Period. Doulas meet with their clients before any official prenatal work is done in order to ensure both parties like the chemistry. That can usually be sensed immediately. If the client decides at the last minute she’d prefer her best friend to you after the work you’ve done together and fails to contact you for the birth, your contract protects you. It is certainly her right to not have you come at the last minute, but your fee is still due. If a baby comes too fast, for example, we still must be paid. A planned Cesarean is still a birth. It is wrong to assume that a doula’s presence is not very valuable for a Cesarean birth. While she cannot go into the operating room with a client much of the time, especially if the mother’s partner is going in to support her, there is much we can do after the surgery.
A doula’s work is so unpredictable, and outcomes are beyond her control. She should not be penalized for her client’s last minute choices. She will not have had time to book another client with such short notice, and this can severely affect her livelihood.
Sometimes clients will expect special services because they decided a doula at their C-section was not necessary, and this is not fair. A doula lovingly and thoroughly prepares her clients for the birth of their baby, however that unfolds. We cannot guarantee a vaginal birth. We can’t guarantee anything. To expect that we’ll just do something convenient for the parents in place of birth attending is like their asking for a free dessert from a restaurant because despite the effort of our crafting a wonderful and elabourate meal that was requested by them, for whatever reason it turned out they didn’t want to eat it, or pay the balance. As it was the customers who came to the restaurant in the first place and placed a request that you have refused other requests for in order to accommodate this one, it is only fair there is financial accountability for the original order instead of having to delve into the chocolate mousse resources to “make up” for the balance they owe. It’s not the restaurant’s fault the client now doesn’t want the caviar and truffle souffle. Now, granted, if the meal were terribly prepared and served, this would be another issue, and should be something the parents can dispute. But generally, signing on for all the prenatal preparation, postpartum follow up, and a birth means that regardless of how the birth has to go, the doula has been asked to provide a service and must be paid according to her contract and not get ripped off because she didn’t replace her service with another coveted one. Birth doulas are not babysitters or night nannies. We attend births. Cesarean is birth. The vast majority of clients who want these other services don’t even ask whether or not this would require a different payment structure or a different service provider…it is apparent to most. But occasionally some don’t, and when this happens, the doula must be firm in standing up for herself, even if this means taking action to get the pay her contract states is owed to her.
I had a client recently who knew before our first face to face meeting she would have to birth via C-section. We decided to do less prenatal visits, decided I would be at the hospital for her and her partner while she birthed, and that I would do extra postpartum work. We were all very happy with this arrangement. I have had other couples ask me, “If I end up having to have a planned Cesarean, I don’t feel I’ll need you there as I’ve been through Cesarean before. Can we have something in the contract which states I can refrain from paying the birth attending fee?” And I will agree to that if they know a few weeks ahead of time. This gives me the opportunity to book someone else in their spot. Requested flexibility is not an issue. However, if a client signs her contract in advance knowing she is bound to pay for birth services, whether she asks her doula to be there or not, then that’s what she needs to do.
Birth attending is an amazing joy. Sometimes births are short and we make quite a great wage if you add it up hourly. And sometimes with loooonggg births, especially if we missed another birth because someone’s birth was very early and loooonngg and another person went very late (this can happen even if you only book one lady per month), you can end up in the hole financially. We have to plan for these occasional contingencies, and take those rare but sad hits. But if our flexible natures which love to serve and to please our clients make us pushovers, we will inevitably get taken advantage of at some point. And yes, it IS true that if we speak up for ourselves and claim our right to decent pay, we can get the reputation of being hard assed. But it also shows we respect ourselves and value our work. Being firm has in fact only helped my business as opposed to send clients running to someone else. When YOU know your value, it is apparent to potential clients as well.
I personally don’t quibble about my prices. I don’t give people money off here or money off there because they feel my price is high. Every doula knows the feeling of walking into the home of someone who owns a BMW or you see a $1000 stroller in the corner, or the couple just came back from a big vacation to Jamaica, and then the clients want to negotiate a “better deal”. I have never had a problem lowering my price for people who clearly are struggling with finances and who seem very committed to investing in their birth experience. A colleague of mine was recently approached by a pregnant teenager who said, “I need a doula, but I have no money. I can bake, and I can knit.” This honest, upfront approach impressed her, she agreed, and they both had an incredibly rewarding experience. If women are genuinely disadvantaged, I send them to a doula organization which specifically helps women in need. But for the vast majority of my clients, my price is my price. Those who initially found it quite high change their minds after the birth is done. The 24 hour on call committment, doing our best and pulling out all stops in terms of support in the throes of extreme sleep deprivation, helping clients gather enough information to make choices that in the end spare them from a potential C-section and the recovery time and breastfeeding challenges ensuing from a high tech birth, having to reschedule sometimes 2 days of appointments, missing our 2 year old’s birthday party, etc…..this kind of service is incredibly valuable, and the far reaching effects of a satisfying birth and postpartum experience are global. When the birth is done, clients are very aware of all you have done.
Doulas out there, you are amazing. Within a scattered, unpredictable, crazy making job, a firm backbone of boundaries in the area of finances is crucial for your mental and emotional health, as well as that of your family. Never doubt your worth.
