The Scoop

So here's the deal - N & I had a great time on vacation last week, visiting family in New England and making a couple quick stops in New Brunswick. We capped off our vacation by unexpectedly helping my parents move. Their move was expected. Our late-night involvement in the move was not. Monday was a very long and intense, but fruitful, staff meeting at non-profit job, and that night was a family birthday party. Tuesday, I found out that the unborn child of a client has a fatal defect. I locked my keys in the car because I was so distracted by this. Once I got in my car again (thanks to my MIL) I was off to help N's family get packed up, as they are heading to West Africa for a month, tomorrow. Tuesday night, just as we were getting ready for bed, I got a call saying the alarm system had gone off at my non-profit workplace so I had to go in and deal with that. We got there (on an 'empty' tank of guess no less!) only to find out it was a false alarm, and they just didn't bother to call me back and tell me (which is a pain, because it meant 30 minutes of driving each way). I found out by email on Wednesday am, that later Tuesday evening, a young adult jumped off the roof of the building and is in critical care. He was not connected to the non-profit, just liked the look of our building I guess??

Wednesday - phew - was a lovely reprieve, as we took in the Canada Day festivities in our small town.

Today was a busy day at work, as I tried to juggle the various groups who use our hall, to make room for a group who really wants to use the hall, and who we really want to partner with. There is a pile of errands that MUST be completed today (things like renewing the plates on my car and putting my paycheque in the bank), then tonight we are supposed to be at N's parents house, to get the rundown on things before they leave (I'm supposed to be the contact person for emergencies, we're taking the family dog to live with us for a month, and we're the back-up help for the people looking after their house). At the same time, we are supposed to be helping my parents move a 12ft x 4ft solid oak table out of their old house and into their new house.

Okay, I've vented sufficiently, and a thunderstorm is rolling in, so I have to go.
Thanks.

How to feel

I learned recently that a client has decided not to have a doula (ie me) for their birth after all. I absolutely respect their decision and why they made it, but can't help feeling a bit disappointed on a personal level. As doulas we're allowed to have a personal level right? Because of course, professionally, it's all about balanced education, and informed choice, and non-judgmental support... and I kind of feel like I shouldn't be disappointed. The insecure piece of me though, says they don't want me because I failed to be all that I should have been. Which I know is a misguided and selfish pov... I know their decision wasn't about me. It was about what was best for them. And that's the way it should be. So a piece of me is also glad for them - that they are learning and growing and making the choices that are right for them as they journey through this pregnancy.

There is still plenty of time for another client to fill in that space, or for me to have a space in which to enjoy the rest of life. Okay. It's all good.

I'm such a geek

Because I'm really excited that my blog is now being featured here and here. The first one is just a top 100 list. And I don't think any of my articles have made it up on the second one yet (I just accepted the invite this week). So that's why I'm feeling like a geek today - because little things excite me.

New client!

I loaned "Pregnancy & Birth" by Teresa Pitman to an acquaintance/friend, who is expecting. A few days later, she asked if she could speak to me. She said,
"When I think back to Cary's birth, I've always just thought it was normal. Average. Standard. I didn't feel bad about it, but I didn't feel great either. It just was what it was. Then I read the book you loaned me. And I realized that Cary's birth wasn't normal. Normal for a hospital maybe, but not normal for what birth should be. I realized that one choice led to one intervention which led to another intervention and so on, until Cary's birth ended up somewhere we never thought it would go, and somewhere it probably didn't even need to go, if we had just known that we could have made different choices. I've realized that I want this birth to be different. So I've been thinking a lot about what my partner and I need to do, in order to have a different birth this time. We've already switched care providers, and we're really comfortable with our doctor's (group) practice. But it's still a hospital birth. We've decided that we need to hire a doula. Are you available? We understand that you can't guarantee anything. And we know that sometimes births don't go smoothly no matter what. But I think having a doula is the right choice for us, to help us have a different birth with this next one."

Yes! Exactly! A Mom gains access to information she didn't have before and realizes she has more choices, and more control, over her body, her baby, her birth, her life. This is very very good.

"what's 'really' going on....."

I attended a wonderful birth. My client was expecting a long, hard, slow induction with all the bells and whistles, but went into labour on her own, and sailed through it. I was convinced by her sounds, and movements, and emotions, that she was very close to pushing/birth. BUT, her internal exam indicated she wasn't. What's a doula to do? I was convinced that she was in the homestretch and that there wasn't even time for meds, but after her internal exam she thought she had so far to go and felt she would have no choice but to use medications because she couldn't do this for an unknown number of hours.... Not 10 minutes later she had an irresistable urge to push and when the nurse looked, she realized the baby was almost crowning! What a whirlwind that was. In the end, Mom & Dad are excited and proud. I'm proud of them! Their little one is beautiful and healthy. All is well.

And ok, I feel proud of myself for being able to read what was happening in Mom's body, even though it didn't match the so-called "real indicator" of cervical dilation. When I thought we were close enough to birth that a nurse needed to know about it, the nurse listened as I explained what I had seen that led me to believe she was close, and the nurse sceptically said "Well, I'll check her cervix and then we'll know what's really going on."
Since the cervix is the door out of the uterus, it obviously has to be open all the way for baby to pass through. But some doors creak open slowly and predictably, while others swing open with a bang! Her body knew that the door was about to swing open, so even though she was still only a few cms dilated when checked, every other part of her body was showing signs that delivery was imminent/that the cervical door was about to break wide open. Some births fool you: you are convinced that Mom is in one place and she's really somewhere else. But for this time at least, I'm glad my eyes were open to see the miracle unfold.

I couldn't believe my ears

Although I skip it as often as I watch it (because sometimes the cesareans and procedures are just too maddening), on "A Baby Story" yesterday, these exact words came out of the mouth of a man about to do a circumcision on a newborn:

"Up to six months he didn't develop any nerve endings. He has no pain. So I don't want you to really think "Why, he's crying because he's in pain."


My jaw dropped. And not in a good way.

Food for Thought (from Midwifery Today Online)

Q: I am writing from Indonesia, the country that got GMO soy first, to share what I am seeing, and to ask if you too are seeing the same. In 2008 Bumi Sehat Bali received 573 babies. We saw an increase in retained placentas. I also am seeing an increase in velamentous cord insertion. In 2008 and so far in 2009 we have seen [far] too many "sticky" placentas; two even had to be transported (we do manual removal on site when absolutely necessary), one for a hysterectomy and one with one liter of blood loss. In the last six weeks of 2008 I had to go after four placentas! It was not pretty, and I do not take it lightly (usually never more than one per year).

Also most shocking is the empirical experience (I have no research to prove it) of an increase of velamentous umbilical cord insertion and short cords. I also am seeing a decrease in Wharton's jelly among all our babies. Cords are also shorter. We don't cut them for a minimum of three hours at Bumi Sehat and many families choose lotus birth. Last week our midwife Ayu had to cut a cord after the birth of the head, as the body would not follow, it was that short a nuchal cord—she had never had to do this before in her life as a midwife.

What are you midwives seeing?

The study I read concerning M16 genetically modified corn showed that when fed to pregnant mice, ALL OF THE OFFSPRING, in one generation, had alterations of ALL the cells in ALL their organs! Can you see why I am worried about our precious placentas? I did not make this connection, until I began to see an increase in abnormalities and pathology due to placenta and cord troubles. The fact that so many Indonesian women depend upon genetically modified soy products (tempeh and tofu) for their day-to-day protein, and the early introduction of GMO soy here got me wondering.

— Ibu Robin Lim
Bali, Indonesia

Not/Guilty

I’m working with a client who really understands what “informed-consent” is. She wants all the available information, so that she can make the best decisions possible for her family. I know some doulas only take on clients who want all the info, but that’s not me. Many of my clients don’t want any of the information. They trust that the nurse/doctor/hospital will do what’s best for them. They hire me, because they’ve heard that a doula can make birth easier, or because they don’t have anyone else to be with them. So when I do have a client who ‘wants to know’, it’s refreshing. And challenging. And sometimes it catches me off-guard.

As I sat and talked with my client about her upcoming birth, she was, like many women, on the fence about whether or not to go with a scheduled induction, and what her stance was on an epidural. She had done a lot of research already, and knew about some of the various risks and benefits of both an induction and an epidural. That being said, she was looking for more info. I recommended she look at “Gentle Birth, Gentle Mothering” by Sarah J. Buckley. It is a fantastic book which caused me to change my thinking on becoming a midwife. If you’re a birth junkie and haven’t read this yet, it is a worthy addition to your library.

The next morning though, I started thinking about the contents of the book a bit more, and worrying that it would make my client feel guilty. Dr. Buckley does not sugar-coat her thoughts, and draws some rather disturbing conclusions about the potential long-term impacts on our children, and humanity, if we continue as is, with many of the procedures that are currently ‘routine’ parts of obstetrical care. (like ultrasounds, inductions, epidurals, and antibiotic eye ointment). If my client decides to have an induction, and an epidural, will guilt prevent her from fully surrendering to her birth experience? Will fear and tension hold her back? Should I have recommended a more main-stream book? Isn’t my job to provide unconditional support? Don’t I believe that the right decision for the mom is the decision she is most comfortable with? How do I walk that fine line between informed consent and non-judgemental support?

And then the thought crossed my mind, that if I hold back the hard information, maybe I’m being an enabler of a broken birth system. If I hold back the hard truths, maybe authors like Jennifer Block in her book Pushed, are right. Am I just holding the blindfold over my clients eyes? In an effort to help women have a ‘positive’ birth experience, am I sugar-coating the harsh realities? When I'm working with a woman who really and truly "doesn't want to know", its almost easier, because all I can do is toss tidbits of info that she might want to grab onto, and do my best to support her as her birth unfolds in a typical North American way.

What am I doing? What have I done? Where do I head next? I’d have preferred to be sleeping in on the weekend, but instead, I was laying awake in bed, 2 hours before I needed to get up, and pondering all the above.

Then it occurred to me, that guilt is not always a bad thing. Guilt occurs when you know you should have done A, and instead, you did B. Guilt is the tool our moral compass uses, to tell us we’re off-track. Of course, there can be false guilt. There can be guilt that paralyzes us. There can be guilt that turns to shame. But guilt can also motivate us to action. It can push us to make difficult decisions, and to walk in new directions.

So – if I provide a client who wants to know more, with resources which may be inconsistent with her previous choices or her future plans, and she feels some guilt, that’s not necessarily a bad thing. Perhaps if more women felt that sort of “good guilt”, and then had the support of their doulas, childbirth educators, midwives…. positive, necessary changes would take place more quickly in our birthing systems.

As a doula, I find that a very fine line to be walking. This client is a well-educated, well-supported, woman. She wants to know more, and has the internal and external resources to sort through difficult information. And, I think anyhow, she knows that I really will support her 100%, whatever she decides. Because in the end, a woman will give birth to a baby – that is a life-changing event, and everyone deserves to be loved and supported through that, no matter what decisions they end up making.

What about my other clients though? The mom’s who are not well-educated, not well-supported, who don’t have the skills, or the background to know that they CAN ask questions? The Mom's who aren't interested in watching a video, let alone reading a whole book? The Mom's who are young and assume that if they don't choose what they think I want them to choose, then I won't like them anymore and won't want to be their doula. (the teenage brain is not a logical brain - they don't make decisions like adults do)

I’ve been considered making up some type of “common interventions informed choice cheat-sheets” for my clients. The two big interventions from my pov are inductions and epidurals, so I’m thinking of starting with those (and moving on to include things like episiotomies, eating in labour, EFM, internal exams etc). I don’t know how exactly to take the work of people like Dr. Sarah Buckley, and convert it to something that is informative, non-threatening, quick to read, and accessible to about a gr 6 reading level (possibly lower).

I've also been thinking of doing environmental cheat sheets called "A Green Baby is a Healthy/Happy Baby" and "A Green Mom is a Healthy/Happy Mom". Or, the more sarcastic part of me is considering titling them "The only thing matters is a healthy Mom & Baby" - since we so frequently hear that in hospitals. Because I would venture to say that the majority of women have no idea that the "Lavender" sleep lotion they rub on their newborn is actually toxic. Or that painting the nursery is harmful. I want to find a way to convey the information in ways that can be grasped, and positively motivate people to change.

It's a big project. The ideas are floating around in my head. They haven't made it to paper yet. When I do eventually get drafts completed, I’ll be sure to let you know.

Changing Bodies??

Women have been having babies for as long as women have existed. And thanks to a variety of factors (better nutrition, better screening tools, better hygiene, surgical techniques etc etc), more women and babies are surviving childbirth. There are of course international variations when it comes to fetal and maternal outcomes, but on the whole, survival rates are better than they were say, 100 or 300 or ‘however many’ years ago. There are also emotional and physical costs associated with the things women and babies often go through, to survive birth. Despite the advancements, childbirth today is not perfect.

For instance, in Canada, 1 in 4 women are giving birth by cesarean section, and in the USA, 1 in 3 women are. Natural birth advocates usually respond to these numbers with comments about how the human race has survived this long without cesarean surgery, there is no way that 25-30% of humans need to be entering the world via a surgical incision now. I hear things like “women’s bodies are the same as they have always been.”

Most of me agrees with those natural birth advocates. And the questions I ask are in no way intended to dismiss the hurt and pain of women who had cesarean births forced on them, or who felt traumatized by their birth experience, or who believe their birth experience was less than it should have been, because of the faulty birth system they gave birth under. It is not meant to "lay blame" at the feet of individual women. But a small piece of me wonders, if there is actually something different with women’s bodies today. (I’m talking North America here, not the world as a whole)

We hear all the time that people now are consuming more refined and processed food, and are consuming it in larger quantities. We’re physically moving less. We’re sitting more. We’re producing larger babies. We are less in touch with our bodies and what they are capable of. We don’t generally have to break a sweat, to keep bread on the table. We are not surrounded by a community of family and friends who have known us since our own births. Knowledge of natural birth, is no longer common knowledge. Is it possible, that all these things are coming together, with the result being higher cesarean rates? Cesareans for failure to progress? for cephalopelvic disproportion? for fetal macrosomnia? For fetal distress? For maternal illness?

And what about the environmental damage we’re learning more about? Is it possible, that the ever-increasing pollutants in the environment are impacting not only our ability to conceive and carry babies, but to birth them too?

I’m not trying to distract from the obvious legal and convenience issues which are often associated with an increased cesarean rate. But what if things really ARE changing? What do we need to do, to turn the tides?

Educating women about their options IN birth, is like putting a woman on a life raft before the ship goes down: It's better than nothing, and it might save that individual woman, but the ship will still go down. Maybe the education needs to go back a step - back to basics - back to eating well and moving often - back to knowing what our bodies can do - back to community.... maybe...
maybe... the ship needs to sink, so that a different boat can come on the scene? Maybe the sea needs to be filled with women on liferafts before a difference will be made? Maybe somebody back on the shore needs to build a different kind of vessel?
Maybe...