by MotherWit | Apr 4, 2010 | Uncategorized
I was checking out Association of Labour Assistants and Childbirth Educators (ALACE) online today, just to reconnect and see what’s going on with them. They are now called tolabour. They have been around since 1983. I took their training in 1993 when they were still called Informed Homebirth/Informed Birth and Parenting. I was attracted to them because the organization was created by midwives, obviously with a belief in the midwifery model of care, regardless of the primary caregiver or place of birth. They put a lot of emphasis on the emotional care of the woman, and constantly challenged the doula to figure out what she would do in any given scenario. My training manual was chock full of information, and there was a substantial reading list.
I absolutely loved my labour assistant training. I’m still not entirely comfortable with the word “doula” to describe my work, and “labour assistant” made people think I was part of a union or something, but I digress…it was a great step in becoming a birth companion. It was a fabulous course, taught at the time by midwife Catherine Stone, whom I still remember with great fondness.
What I loved about it, and they still continue to do this today, was the opportunity to do some hands on physical stuff. Not because they promote this as something a doula should do, but to get a deeper, visceral understanding of what women go through prenatally and in labour. I was taught to find fetal heart tones with a fetoscope for the purpose of identifying where a baby is lying, palpation, and basic pelvic examination. While I know this may make some doulas squirm with discomfort, let me reassure you for a moment. I do not do pelvic examinations in my practice. For one, learning how to examine the cervix of a woman neither pregnant nor in labour is not at all teaching someone how to check how dilated someone is. This would take a lot of hands on training in the field, which is obviously beyond the scope of a doula’s work. The intent behind this exercise was for us to get a feel for this cervix thing we talk so much about. How empowering it was, within a safe environment with a certified midwife, to get a better understanding of the landscape of the female pelvis via the vagina! I know what an ischial spine feels like now and I truly understand the mobility of the coccyx. My fingers will never forget that sensation! But most important to the learning, especially for those who maybe had not had children before, was being in a position to be on the receiving end of the exam with onlookers. I think this is what the exercise was mostly about….to gain empathy and to receive the support of the student doula holding our hand and guiding us in relaxation.
What people need to know is that learning a basic pelvic exam is not in any way, shape, or form a licence to check a lady’s cervix during labour. While some may argue, “Well, an oncologist doesn’t need to have had cancer to be excellent at what he does, so why would you have to know what a cervix feels like to be an excellent doula?” Good question. You don’t. I don’t think you need to have done or received an exam or even had a baby to be a fabulous doula. But like the oncologist who is also a cancer survivor, with a little personal experience, some depth is gained. There is a difference between gaining empathy through hands on work for experiential purposes and giving permission to diagnose a cervix in labour.
I continue to palpate bellies and stick with belly mapping, which I find is an empowering exercise for a mother and her partner to connect with their baby, and for the mother to remember to maintain good posture if she notices the baby’s back shifting throughout the day. I have owned my fetoscope for 18 years, and on the odd occasion, if we’re not convinced of where the baby is, I might show the mom how to find the heart it if it’s possible. I often leave my fetoscope with the family so they can listen to their baby once in awhile. Mothers of twins love this! It has been through many sets of hands and heard many heartbeats. I do not think this is “diagnosing” or doing anything clinical. Check out spinningbabies.com created by Gail Tulley who is a midwife and DONA certified doula for more info on belly mapping. I NEVER have and NEVER will look for fetal heartones at home during childbirth, because that crosses the line between empowering parents and clinical care.
The question my clients always ask is, “If you are with me at home, how do we know when it’s time to go to the hospital if you don’t check my cervix?” As a doula, I find this is an easy question to answer. I observe the mother’s labour, and rarely look at a clock. I don’t generally time contractions. If things are getting much stronger, we usually know without a clock telling us that the contractions are longer and closer together (in most cases, but not all). I listen to her breathing and sounds. I check for the obvious signs of endorphin release written on the mom’s face. When the mom begins to seem like she has gone from early labour to “active labour” according to our combined maternal/paternal/doula spidey senses (which I don’t think has much to do with a number of centimetres, as I have had women who are in extremely active labour when the doctor tells them they’re 2m, as well as women at 8cm who are still hovering on the fence between early and active labour), we go directly to the hospital. And what if we are proven wrong at the hospital, that labour is indeed still early? Well, we haven’t made a mistake. Because if the mother is having what appears to be very strong contractions she can’t speak through and looks all stoned between them (endorphins), the contractions seem long and quite frequent, then moving to the hospital where the baby and mother will be monitored by her primary caregiver at whatever interval they feel is appropriate is important, no matter how much longer there is to go in the labour. Of course, if a client wants to go before or a bit later than this guideline, that is her choice, but I make sure they understand the information surrounding each choice. So far, I’ve never caught a baby in a car 🙂
My doing a vaginal examination to try to figure out whether or not it is a good idea to stay at home longer could be potentially detrimental to the mother and baby. For one, I stand by my claim that a number doesn’t mean much. We experienced birth attendants know how changeable a cervix is. My trying to figure that out and come up with a magic number only puts the mother in a state of more discomfort, and my “judgement” may potentially keep her from the hospital when it’s a good time for her to be there, having the baby listened to now and then. If labour looks active, even if it’s technically not, a midwife at a homebirth still listens to the heart tones periodically. A woman chooses to have a hospital birth because this is where she feels she will be safest, and this is where she receives the clinical care that determines her and her baby’s well being. Staying home with just a doula for a very long labour, especially since a doula doesn’t listen to heart tones, is not usually something a client would choose to do when properly informed about the doula’s scope of practice. It would be different if that doula was also a monitrice, but I am personally not one. That’s a responsibility I don’t want.
So thank you, ALACE, for providing me with the tools for the long and satisfying career I have been enjoying. You ladies are AWESOME!
by MotherWit | Apr 3, 2010 | Uncategorized
What a gorgeous day! I cleaned up my flower gardens, so happy to see shoots poking their little faces through the earth to meet the sunshine in person. My children were so happy to go to the park where we built sand cities then pretended we were Godzillas. I feel blessed to be spending time with my loved ones, visiting mothers and mothers-in-law, revelling in the return of warmth.
I am thankful for the global network of doula sisters, from whom I learn so much. I appreciate it all: the support, the commiseration, the challenge, the conflict….it all creates growth, and I trust it’s all there to make me the best possible birth attendant I can be, and best teacher I can to those who are entrusting their educational process to me. I am profoundly honoured to have women interested in my guidance, which truly, aside from information, is all it really is.
Off to eat chocolate and chicken, most likely in that very order. Happy April!
by MotherWit | Apr 2, 2010 | Uncategorized
Just to let everyone know, my good friend Sarah and her soapmaking Goddess friend Alysia are opening up a cool new store. I went over there today to help them out for a little while, and it is a great space. The store is an herbal pharmacy….all those things you have a hard time finding, like homeopathic Caulophyllum 200, helichrysum essential oil, or pokeroot? You’ll find ’em there. There are also great body/hair/baby products, along with Alysia’s (Savon Populaire) soap, and Applecheeks cloth diapers (which are truly amazing). It’s going to be a fun place to come shop and chat with people EXTREMELY knowledgeable about the products they sell. Sarah has been an herbal healer for nearly a decade, and Alysia has been making soap and teaching soapmaking to people for a long time. They’re both nursing moms and carry their little ones around in Ergos while they paint, stock, make calls to suppliers, organize, etc. They are remarkable.
The store is called L’essentiel et les petits riens….. You’ll find them on 273 St. Zotique between Henri Julien and Alma, just a hop away from Beaubien Metro. They’re having a 5 a 7 to celebrate the grand opening on Thursday, April 8th.
Please come support our local merchants/craftspeople. These are people who deserve success. Hope to see you there!
Their website is:
www.magasinlessentiel.ca
by MotherWit | Apr 1, 2010 | Uncategorized
I woke up to some nice news. A nice lady from nursepractitionerschools.org informed me that I was listed in the top 50 blogs for midwives. It’s organized so that midwives are first, organizations are next, nurses are next, then doulas are at the end. I am proud to be in the “doula” section. After all, where else would I be? I was super happy to see my favourite blogger The Navel Gazing Midwife up there.
My talk with author Holly Dressel was lovely yesterday. She thought, “Hey! They should have doulas for EVERYTHING you have to do in a hospital!” Wouldn’t it be great too, if you were terrified at the dentist, to have a nice lady hold your hand and let you know your fears were acceptable and that they would be tended to? The word “doula” (even though I just can’t vibe with this word itself, always knowing the true meaning of it is “bonded slave”) embodies the essence of support, tending, and love. In any case, I think I gave an accurate description of what doulas do and what we’re about.
I simply could not imagine doing anything else.
Thanks to one Ms. Jasmine Hall for sending me the kudos.
http://nursepractitionerschools.org/50-best-blogs-for-midwives/
by MotherWit | Mar 30, 2010 | Uncategorized
I’m super excited, because tomorrow I will be meeting with Holly Dressel, who has co-authored books with David Suzuki, as well as done some of The Nature of Things shows. She is an amazingly engaged, involved lady, and an important voice on the subjects of environmentalism and healthcare. Holly is embarking upon a writing project with an OB/GYN friend of hers on the over-medicalization of birth. Guess what doula she’s interviewing? Oh yeah, it’s me…doing a little happy dance. I promise to represent us in a way that will make y’all proud. I know it’s a big responsibility, and I don’t take it lightly.
My agenda is to emphasise the importance of the emotional support a doula provides throughout the childbearing year to bring balance to births in higher tech settings (than home), emphasising that for women choosing to birth in a hospital, they can have what they perceive to be the best of both worlds….good clinical care with access to technology if necessary, and attention to their comfort/support needs and solid continuity of care. I will will also dispell some myths that we’re all about only natural birth, and explain that we advocate choice. I will also discuss the role of doulas in out of hospital births with midwives, and talk about the studies done by Klaus and Kennel which give evidence of the efficacy of our care. I will mention the important organizations upon whose shoulders all doulas stand, whether or not they are affiliated with anyone in particular, and discuss how our job is to educate and provide proper information, and to be part of a team, meaning we work with the decisions of primary healthcare workers and their patients (our clients), keeping our own agendas out of it.
Wish me luck!
by MotherWit | Mar 27, 2010 | Uncategorized
Hello All,
As I’ve mentioned, I will, providing all is politically stable and enough resources can be gathered, be going to Madagascar in September.
I am now a member of Taratra Reny Sy Zaza, which means “Shining Light, Mothers and Children”. This group was founded by the traditional midwives, mothers, and young women of Mahatsinjo, Madagascar, whose mission is to promote women and children’s health in that region.
Karen Samonds, family physician Deborah Golberg, midwife Sarah Hunter and I (doula Lesley Everest) will be going to Madagascar to do an educational exchange with the midwives there, as well as hopefully with the doctors who work from the Tsinjoarivo hospital 15 km away from the area we will be staying.
The intent of this trip is to give the midwives some basic equipment (they have nothing), some training in preventing and dealing with complications in the childbearing year, as well as trying to improve conditions in the hospital (which is an 8 hour walk away). Karen sent me some photos of the Tsinjaorivo hospital, and there is basically a slab in the middle of a “delivery”room (and that’s it), and a couple of recovery cots. A few basic pieces of equipment, medications, and some training could do wonders in lowering the rates of newborn and maternal death in this region.
This will not be a case of “helicopter medicine”, where we Western folks sweep in haughtily, telling everyone they’re doing it all wrong, dumping a limited supply of equipment without proper instructions, and then take off with a “good luck”. These workshops will be conducted with the utmost respect for the tradition and vast amount of experience the midwives have. The Taratra midwives who are good friends of Karen, who has spent many months per year in Madagascar out of the last 10 years of her life, told her these workshops are something they want. And we are fascinated to learn of how they deal with complications in birth. As a doula, I am really excited to learn about the massage techniques they use to treat infertility, and am curious about how they support a mother in a long birth. Karen told me their approach to birth is very much like that of a doula.
Some of the areas Karen and the midwives have identified as being useful to focus on are:
1) Contraception and STD prevention. Many of these women have more children than they want, and really want to know how to prevent conception. They were not aware that there are more fertile times in the cycle than others. Also, condoms were not something known before. Men tend to have multiple partners, so STDs are an issue. Male and female condoms will be huge on our list of things to bring or have donated and shipped.
2) Nutrition throughout the childbearing year. Malnutrition is a huge issue for the women of Mahatsinjo. They have many children, do not have an adequate diet, work extremely hard, thus often don’t have the strength to cope with things such as lots of blood loss in labour. Pre-eclampsia is very common. The diet consists of rice, manioc, and other really starchy things. Some fruits and vegetables are available, but it is not known by the women what can provide better nutrition. Also, smoking and drinking rum are habits that are common, and not known to be harmful to a developing fetus. Vitamin A deficiency is a huge problem. Donations for prenatal vitamins for women and children are being arranged, as well as a workshop in prenatal nutrition.
3) Equipment and skills. As I mentioned, midwifery skills are very basic, and there is no equipment. We’re coming up with a list of things that will help the midwives do their jobs more easily, as well as things that will be helpful to equip the small hospital. A hanging scale for babies, tape measures, fetoscopes, blood pressure cuffs, stethoscopes, suturing equipment, drugs to control bleeding, etc. are part of the list, and we are hoping to get all of these things donated and sent over, or to raise the funds to buy them. The doctor and midwife on the team will do trainings to enhance the skills of the midwives and hopefully doctors in this region (Advanced Life Support Obstetrics). Teaching basic neonatal resuscitation procedures as well will most likely reduce the rate of neonatal mortality considerably. There are some books also on the list of necessities that will help provide information to a reader who perhaps doesn’t actually read, but learns from pictures.
4) Breastfeeding and infant nutrition. Karen told us that the women there are not aware that colostrum is extremely valuable to the health of the newborn. Breast milk is not seen as the amazing nutrition we know it to be. When Karen arrived in Madagascar with her first child, the women could not believe that a baby could be so chubby and hale with exclusive breastfeeding. Coffee is given to infants in order to “give them strength”. Low birth weight and diarrhoea are common causes of infant death in this region. We are hoping basic information about the nutritional and immunological benefits of breastfeeding will go a long way in preventing the extremely high rate of illness and death in young children.
Other topics will arise as we do more planning, but these are the basic things we have been discussing.
What we need is to raise funds! I am putting this out there in the hopes that it will get passed on and the word will get out. Any sponsorship, donation, funding, volunteering of time to help fund raise, etc. will be a blessing. Karen has gotten funding from the African Women’s Development Fund, but it is not enough to have the team or the equipment that will make the best of our time in Mahatsinjo. We are asking for help! Information about the Sadabe organization (which was founded by Karen and her husband Mitch, and seeks to find a better and more effective coexistence for Madagascar’s humans and its wildlife) and Teratra Reny Sy Zaza can be found at http://www.sadabe.org/ You also have the opportunity to make donations on that site, or you can contact me at info@motherwit.ca I will be putting something on my site for donations soon as well on http://www.motherwit.ca/ We are also thinking of holding a silent auction, so donations of products or services are welcome as well.
You have the opportunity to make a profound difference in the lives of these women and children by helping us provide the empowerment they are asking for to develop their knowledge and skills in caring for themselves and their community. You will be honoured on the Sadabe website as a friend and supporter.
Please pass this on and help us make this trip a reality!
Thank you, and have a wonderful weekend
