...it's important to try to remember the times when I may have done something that changed one person's mind or experience a little bit.
The normal newborn exam. At my most recent birth, the family doctor wanted to examine the baby, but the mother was reluctant to give her up. I asked if it could be done where mother could see. The doctor said sure, and motioned to the infant cart, which was several feet away against a wall behind the mother's head. I asked if it could be moved closer. The nurse pointed out that it was under the warmer, which was bolted to the wall.
I mused about how at home they do the newborn exam beside the mother on her bed, but too bad that the hospital bed was too small for that. The doctor then suggested that perhaps he could do it with the baby right where she was - skin to skin with her mother. Sometimes the indirect method works better than my asking for something for my clients outright. I wonder if he'll think about doing that at his next birth?
Pushing. Once, I had a client in hospital with a medical student observing. She was beginning to push, and needed to pee. The nurse, per protocol, did not want the mother pushing on the toilet - they always think the baby's going to fall in. With a first baby, when a mother's just begun to feel pushy, the risk is vanishingly small. I said something of the sort, and the nurse agreed to let the woman go as long as she promised not to have the baby there. :-)
When she came out of the bathroom the mother asked me for help understanding a squatting position. Before she got back on the bed I demonstrated squatting by holding onto the bed and squatting on the ground. I intended to help her do this on the bed, but she got right down beside me and began to push in a very focused way. The nurse was a bit flustered, and whispered that she was concerned about not being able to see what was going on. So I turned on the mini maglight that hung around my neck, and the nurse and I proceeded to sit or kneel on the floor and watch the mother's perineum by flashlight.
I was thrilled that all of this was happening, but even more thrilled that it was happening in front of a med student. She got to see a midwifery-style labour in the hospital that night. I was pleased that we had a nurse who was flexible and willing to let curiosity override custom.
IV for antibiotics. GBS protocols have been a moving target over the last ten years. A few years ago the standard of care at the hospitals around here was to start an iv in active labour, hang a bag of antibiotics, and keep the iv running with ns or rl for the rest of the labour. Then I attended a home birth with a client who was GBS+. When the time came, the midwife started an iv, ran in the antibiotics (hanging the iv bag from a coathanger hung on the edge of a door), and then disconnected the iv tubing and capped the iv port. Four hours later, she reconnected the iv for the next dose of abx.
So, the next time I had a hospital birthing client who was GBS+, I told her this story. She asked her ob about it, who said "I don't see why not" and placed instructions in her chart. From then on I encouraged every client to talk to their doctor about this option. At first the nurses thought it was odd, but they are now encouraging it for clients who want an unmedicated birth and want their freedom of movement. I'm sure hospital policies have not changed because of my small handful of clients, but I'm sure their requests didn't hurt.
There must be more - I'll try to dig one up whenever my flagging spirits need a boost.
Friday, May 22, 2009
Wednesday, May 13, 2009
Maternity care where I live
We all know that choosing your doctors is important. You may be looking for different things from different kinds of care providers. If you're looking for a heart surgeon, you might want someone with lots of experience in the procedure you need, who's affiliated with a hospital with an excellent reputation, and if s/he'll also take the time to explain things to you it's a bonus. With a shrink you want someone with whom you feel safe, who's patient, and who won't talk down to you. With maternity care providers you want someone who will take the time to really answer all your questions and who shares your philosophy of childbirth. All the books say that this is the most important thing you can do to have the kind of birth you want.
With most specialists there is an ongoing relationship. If you do not feel comfortable with a doctor you can ask for another referral, you can change. With an obstetrician there is an ongoing relationship during the pregnancy, but that person may not be there for the birth. When you're giving birth there is really no option to cancel the appointment, walk out, and start looking for a different doc.
In Toronto, Ontario in the current health care environment, family doctors, obstetricians and midwives are all in short supply. Women are rarely able to interview care providers and choose one who suits them and their family - care providers just don't have time because they're struggling to see the patients/clients they already have.
Many women who would have liked to have a midwife find that if they wait until six weeks of pregnancy (which, let's face it, is when many of us are just starting to realize we've missed a period - not all pregnancies are planned to the minute) then the midwives are all booked up. There may be waiting lists, but no assurance that your name will ever make it to the top. If you do get an appointment, you take the first midwife you can see, because if you don't book with her immediately you might miss your chance. You might not think to ask about holiday schedules, about off-call time, about the chances of having your primary midwife at your birth.
Doctors are run off their feet. With the encouragement of the government and to try and balance the demands of an over-full obgyn practice and a personal life, most doctors work in group practices of varying sizes. Everyone in the group shares call. Some of my clients have doctors who are in groups of 10, 12 or more. So, their chance of seeing their own doctor on the day they give birth is 1 in 10 or worse. Meeting the other doctors in the practice is impossible under these circumstances. There are a small number who make a point of attending their own patients - some of them are extra dedicated, and some just don't play well with others.
So, that means that by far the majority of my clients are attended in labour by people they've never met before. Those who were aware that this would be the situation from early in pregnancy often don't bond with their care providers: "oh, he's okay, but he's not going to be there anyway so it doesn't matter".
As a doula I find it really frustrating to try to help families achieve the kind of birth they want. I can help them have good conversations with their doctor, I can help them write a birth plan and have the doctor give feedback, perhaps put it in their chart, we can luck out and get assigned a nurse who is interested in hypnobirthing/natural childbirth/etc and happy to support a calm environment, and then you can have an on call ob who walks in, flips on the lights, orders a woman onto her back and starts managing the birth according to their standard high-intervention operating procedure.
Even with midwifery care you can run into disconnects. A couple of times I've had clients planning water births who happened to go into labour on a day when their primary midwife was off call, or had another client in labour. The midwife who arrived was not well known to the client, was nervous about water births, and undermined the client's plan.
I can help clients plan, I can help them access information and discover options they didn't know were available. I can help them express their needs and wishes. But I can't change their birth place, their care provider or the underserved health climate we live in. If any of you have any ideas on how to work this way (other than UC!) please share.
With most specialists there is an ongoing relationship. If you do not feel comfortable with a doctor you can ask for another referral, you can change. With an obstetrician there is an ongoing relationship during the pregnancy, but that person may not be there for the birth. When you're giving birth there is really no option to cancel the appointment, walk out, and start looking for a different doc.
In Toronto, Ontario in the current health care environment, family doctors, obstetricians and midwives are all in short supply. Women are rarely able to interview care providers and choose one who suits them and their family - care providers just don't have time because they're struggling to see the patients/clients they already have.
Many women who would have liked to have a midwife find that if they wait until six weeks of pregnancy (which, let's face it, is when many of us are just starting to realize we've missed a period - not all pregnancies are planned to the minute) then the midwives are all booked up. There may be waiting lists, but no assurance that your name will ever make it to the top. If you do get an appointment, you take the first midwife you can see, because if you don't book with her immediately you might miss your chance. You might not think to ask about holiday schedules, about off-call time, about the chances of having your primary midwife at your birth.
Doctors are run off their feet. With the encouragement of the government and to try and balance the demands of an over-full obgyn practice and a personal life, most doctors work in group practices of varying sizes. Everyone in the group shares call. Some of my clients have doctors who are in groups of 10, 12 or more. So, their chance of seeing their own doctor on the day they give birth is 1 in 10 or worse. Meeting the other doctors in the practice is impossible under these circumstances. There are a small number who make a point of attending their own patients - some of them are extra dedicated, and some just don't play well with others.
So, that means that by far the majority of my clients are attended in labour by people they've never met before. Those who were aware that this would be the situation from early in pregnancy often don't bond with their care providers: "oh, he's okay, but he's not going to be there anyway so it doesn't matter".
As a doula I find it really frustrating to try to help families achieve the kind of birth they want. I can help them have good conversations with their doctor, I can help them write a birth plan and have the doctor give feedback, perhaps put it in their chart, we can luck out and get assigned a nurse who is interested in hypnobirthing/natural childbirth/etc and happy to support a calm environment, and then you can have an on call ob who walks in, flips on the lights, orders a woman onto her back and starts managing the birth according to their standard high-intervention operating procedure.
Even with midwifery care you can run into disconnects. A couple of times I've had clients planning water births who happened to go into labour on a day when their primary midwife was off call, or had another client in labour. The midwife who arrived was not well known to the client, was nervous about water births, and undermined the client's plan.
I can help clients plan, I can help them access information and discover options they didn't know were available. I can help them express their needs and wishes. But I can't change their birth place, their care provider or the underserved health climate we live in. If any of you have any ideas on how to work this way (other than UC!) please share.
Really back now - and the baby's okay
I attended my first birth last week - my first birth since coming back into doula work after nearly two years off. Lovely family, very inquisitive, worked hard to get the birth they wanted. Nearly sabotaged by an ob resident who just was not on the same page at all.
It really does feel like I never left. I've been wondering what sort of changes I would see in the hospitals I go to, the care providers I come in contact with. I was very excited about this birth because the parents were just so willing to ask questions, do some research, do some work and keep their experience and their baby's experience of childbirth as centrally important concepts.
Sometimes people have difficulty getting it, though. Even a family member, when I was talking about my disappointment in the care my clients received, said "but was the baby okay?". Yes, the baby was okay - of course the baby was okay. The doctors want the baby to be okay, I want the baby to be okay, and I guarantee you that the parents want the baby to be okay more than the rest of us put together. If it happened that the baby was really not okay, the parents would be more than willing to change their plan and do what was necessary. But that's not all that matters.
Have you had an experience with a doctor who was overbearing, who tried to scare you into compliance, who steamrollered over your requests because "that's the way we do it"? Were you okay? Were you okay physically? Were you okay emotionally? If the answer was yes to the first but no to the second, did you go back? Many of us have changed specialists because we did not feel emotionally okay with the person. Sometimes we're able to separate these feelings to the extent that we realize the person is probably competent and will do their job well, but we just don't like them. Sometimes we can't separate those feelings: a doctor who makes us feel bad emotionally may very well leave us feeling that we can't trust their clinical judgement, and we just don't feel safe with them.
Feeling safe is critical in birth. Fear and anger flood the body with the kind of stress hormones that can slow labour, create tension in the muscles and make it very difficult for a woman to release - or even want to release - her baby out into the world. Late in labour, fear for her child's safety can make a woman push in ways that may be designed to get the baby out faster, but which compromise her oxygen supply (and thus the baby's), increase her risk of tearing, and affect her ability to welcome her baby with openness and joy, rather than just relief.
On the provider's side, fear and anger make a patient/client suspicious, resistant, and disconnected. Why on earth would you want that? If you can gain compliance, get your patient to do things your way, you may have a good outcome: a physically healthy mother and baby. But what about their emotional health? What about your emotional health? It can't feel good to be having to bully patients into compliance. It can't feel good to have families toss you out of the room and know they're discussing your actions in your absence. On paper, the baby may be okay, the mother may be okay, your actions may be okay. But is that really all that matters?
It really does feel like I never left. I've been wondering what sort of changes I would see in the hospitals I go to, the care providers I come in contact with. I was very excited about this birth because the parents were just so willing to ask questions, do some research, do some work and keep their experience and their baby's experience of childbirth as centrally important concepts.
Sometimes people have difficulty getting it, though. Even a family member, when I was talking about my disappointment in the care my clients received, said "but was the baby okay?". Yes, the baby was okay - of course the baby was okay. The doctors want the baby to be okay, I want the baby to be okay, and I guarantee you that the parents want the baby to be okay more than the rest of us put together. If it happened that the baby was really not okay, the parents would be more than willing to change their plan and do what was necessary. But that's not all that matters.
Have you had an experience with a doctor who was overbearing, who tried to scare you into compliance, who steamrollered over your requests because "that's the way we do it"? Were you okay? Were you okay physically? Were you okay emotionally? If the answer was yes to the first but no to the second, did you go back? Many of us have changed specialists because we did not feel emotionally okay with the person. Sometimes we're able to separate these feelings to the extent that we realize the person is probably competent and will do their job well, but we just don't like them. Sometimes we can't separate those feelings: a doctor who makes us feel bad emotionally may very well leave us feeling that we can't trust their clinical judgement, and we just don't feel safe with them.
Feeling safe is critical in birth. Fear and anger flood the body with the kind of stress hormones that can slow labour, create tension in the muscles and make it very difficult for a woman to release - or even want to release - her baby out into the world. Late in labour, fear for her child's safety can make a woman push in ways that may be designed to get the baby out faster, but which compromise her oxygen supply (and thus the baby's), increase her risk of tearing, and affect her ability to welcome her baby with openness and joy, rather than just relief.
On the provider's side, fear and anger make a patient/client suspicious, resistant, and disconnected. Why on earth would you want that? If you can gain compliance, get your patient to do things your way, you may have a good outcome: a physically healthy mother and baby. But what about their emotional health? What about your emotional health? It can't feel good to be having to bully patients into compliance. It can't feel good to have families toss you out of the room and know they're discussing your actions in your absence. On paper, the baby may be okay, the mother may be okay, your actions may be okay. But is that really all that matters?
Thursday, February 26, 2009
Dipping my toe back in the water
Well. It's been a long time. I'm returning to doula work after a long break, and thought I'd see what's been happening in the blogosphere while I'm at it. (Do they still call it that? And so many of you have moved - is there something I should know?)
I hope Facebook hasn't killed too many blogs. It's a very different medium - fun for keeping in touch, but not for having Deep Thoughts. I've been using it socially for a while, but I'm just beginning to experiment with using it professionally. At this point, I'm keeping the links between this blog and my "real" life. I'll reevaluate that as I go along, however.
So anyway, if you find this please say hi. I'll be out looking for the usual suspects.
I hope Facebook hasn't killed too many blogs. It's a very different medium - fun for keeping in touch, but not for having Deep Thoughts. I've been using it socially for a while, but I'm just beginning to experiment with using it professionally. At this point, I'm keeping the links between this blog and my "real" life. I'll reevaluate that as I go along, however.
So anyway, if you find this please say hi. I'll be out looking for the usual suspects.
Wednesday, August 02, 2006
Queer Positive Prenatal Classes in Toronto
So in the interests of full disclosure and (shameless self) promotion, I want to alert any readers who may know or work with folks in the Toronto area that it looks like we're going to be offering another series of Queer Positive Prenatal Classes through The 519 Community Centre.
The new coordinator of Queer Parenting Programs has been discussing a change to these classes, so I didn't know if we'd be doing another series, or at least whether we'd be doing another series in the existing format. But it looks like a weekend intensive in October will be happening - possibly the 14th & 15th which is the weekend after Thanksgiving. Date and location are not yet set, but if you want more information please contact Chris at The 519.
I've participated as a facilitator in four or five sessions now - since the beginning, I think - and it's been a very interesting experience. Calling them "Queer Positive" rather than "Lesbian" or even "Queer" has meant that we've successfully conveyed the message that these classes are not just for lesbian couples. So far, we've had a really wide variety of family configurations, and it's been a wonderful challenge for me personally to ensure my content and attitudes are as inclusive and as free of bias as possible.
I'm looking forward to doing it again.
The new coordinator of Queer Parenting Programs has been discussing a change to these classes, so I didn't know if we'd be doing another series, or at least whether we'd be doing another series in the existing format. But it looks like a weekend intensive in October will be happening - possibly the 14th & 15th which is the weekend after Thanksgiving. Date and location are not yet set, but if you want more information please contact Chris at The 519.
I've participated as a facilitator in four or five sessions now - since the beginning, I think - and it's been a very interesting experience. Calling them "Queer Positive" rather than "Lesbian" or even "Queer" has meant that we've successfully conveyed the message that these classes are not just for lesbian couples. So far, we've had a really wide variety of family configurations, and it's been a wonderful challenge for me personally to ensure my content and attitudes are as inclusive and as free of bias as possible.
I'm looking forward to doing it again.
Article: May Doctors Refuse Infertility Treatments to Gay Patients?
This is an interesting article. (Requires free sign up.)
I found my opinion pinging back and forth throughout. I'm opposed to all forms of discrimination, and I'm particularly sensitive to discrimination against queer people. And yet I hear the argument that health care providers should not be forced to violate their personal ethics - or at least not where alternative services/providers exist. Where there is no reasonable alternative, I think you've got to do the job you've been hired to do, regardless of your own squicks.
Ultimately though my position is firm: sexual orientation and gender expression are rightfully grounds on which no one may discriminate against an individual, any more than they may discriminate on the grounds of skin colour or apparent gender.
(I am very tempted to take on the notion of "bona fide religious objections" - does being a "Christian" really get you off the hook? - but will refrain as I'm likely to get out of my depth very quickly, and others have done it better. But even if they're bona fide, gee, if you're a member of the Klan, can you refuse to treat Black people as a matter of religious conscience?)
I don't expect to see this kind of thing at a Canadian clinic at the moment. The extent to which religion plays a part in US society is pretty foreign to the way we generally do things. However social trends do seem to creep over the border, so we do well to keep an eye on things. In looking around for links for this post, I was flabbergasted to find an article on Ask.com about how to deal with being an atheist in the office, and how you can handle things like office prayer meetings. Office prayer meetings? For real? I'm gobsmacked. I live in an environment where religion is considered a very private matter - no one else's business, and not something you either hide or fling around publicly. It just *is*. However I'm now getting into the territory of another post entirely, and one that probably doesn't belong in this blog.
So back to the matter at hand. Should health care providers have the right to limit their practice? What constitutes acceptable grounds for doing so? And is sexual orientation ever an acceptable ground?
I'd love to hear what others think.
I found my opinion pinging back and forth throughout. I'm opposed to all forms of discrimination, and I'm particularly sensitive to discrimination against queer people. And yet I hear the argument that health care providers should not be forced to violate their personal ethics - or at least not where alternative services/providers exist. Where there is no reasonable alternative, I think you've got to do the job you've been hired to do, regardless of your own squicks.
Ultimately though my position is firm: sexual orientation and gender expression are rightfully grounds on which no one may discriminate against an individual, any more than they may discriminate on the grounds of skin colour or apparent gender.
(I am very tempted to take on the notion of "bona fide religious objections" - does being a "Christian" really get you off the hook? - but will refrain as I'm likely to get out of my depth very quickly, and others have done it better. But even if they're bona fide, gee, if you're a member of the Klan, can you refuse to treat Black people as a matter of religious conscience?)
I don't expect to see this kind of thing at a Canadian clinic at the moment. The extent to which religion plays a part in US society is pretty foreign to the way we generally do things. However social trends do seem to creep over the border, so we do well to keep an eye on things. In looking around for links for this post, I was flabbergasted to find an article on Ask.com about how to deal with being an atheist in the office, and how you can handle things like office prayer meetings. Office prayer meetings? For real? I'm gobsmacked. I live in an environment where religion is considered a very private matter - no one else's business, and not something you either hide or fling around publicly. It just *is*. However I'm now getting into the territory of another post entirely, and one that probably doesn't belong in this blog.
So back to the matter at hand. Should health care providers have the right to limit their practice? What constitutes acceptable grounds for doing so? And is sexual orientation ever an acceptable ground?
I'd love to hear what others think.
Saturday, July 29, 2006
An Unplanned Home Birth
This is my favourite birth story from the past.
***
If I never really connect with another client, it'll be okay. I've done what I needed to do. I'm a little awed by having had the chance to be someone's catalyst for change. Just a catalyst - the change was in process. But for the rest of my life I'll hear her voice shouting, "Rean! Women's bodies are strong. *My* body is strong!!" I'm so glad I was able to participate in this.
Today she gave me a gift with a tag that read:
With permission comes choice.
And making choices based on what I want
and not what somebody else is telling me,
feels so empowering.
Thank you for giving me permission.
***
A woman hired me for postpartum breastfeeding support with her second child, due in a couple of months. She asked if she could come to me for some counselling to process her first birth experience, which sucked from her point of view. She's a woman of strong moods and opinions, but a lovely person with an engaging personality. She had a doula at her first birth - a friend who was new at it and who froze. It was a bad experience. We’d been talking for several weeks and her due date was upon us. At the last minute, she finally asked if I would attend her birth. I think she realized that her desire to labour entirely alone came in part from feeling there was no one she could trust to really be there for her. She came to trust me.
Among her issues were real problems with breastfeeding last time. Combined with a birth that was speeded up chemically until she could no longer endure the contractions and opted for the epidural she had so wanted to avoid, she had a lot of "my body doesn't work" stuff going on. She experienced postpartum depression that went unspoken of and untreated. At the root of the broken body stuff was growing up as the fat kid in a family of thin, pretty people. At 11 she was on the swim team, playing soccer, and on her first diet. She is now tall, graceful, with luxuriant hair and gorgeous skin. She is also very obese. She has no idea she is beautiful.
She knew she wanted to labour at home as long as possible as a way of avoiding hospital interventions. However, she knew she'd only really feel safe planning a hospital birth as she works with special needs kids, some of whom have special needs as result of birth injuries. She felt she needed the reassurance of the hospital, but was very conflicted about that need.
So, she went past her due date. Her care provider started talking induction. She resisted for a certain amount of time, but agreed to do it at the end of the week following her date. She was prepared to just throw away her natural birth desires in the face of this intervention, with an air of really giving up. Happily, she went into labour herself the day before she was scheduled to be induced. It went off and on all day, and we stayed in touch by phone. I ended every conversation by telling her I was ready to come whenever she wanted me there. She finally called in the evening to say it was getting hard and she needed help. I found her in what I judged to be early labour, contracting hard and fast, q2-3min, but only lasting 30 seconds. No bloody show at all, waters intact. Having a hard time, but talking between contractions.) She had started at 4:30am, so I figured there were many hours to go. Things started to change after I'd been there an hour and a half or so, and I thought we were seeing a move into active labour.
(Vomiting, then into the shower, then back and tearful. Her waters releasing while sitting on the birth ball, clear, still no show. Contractions finally seem to be lengthening a bit. I thought we were seeing the 4cm mini-transition women sometimes experience.)
That would mean we still had a few hours to go. A bit later she says she thinks it's time to go in to the hospital. I've been there for two hours. Her husband gets her clothes, I start getting her up and ready. Then, she makes a funny noise during one contraction, and I look at her when it's done and ask if she was pushing just then. She says something along the lines of, "well *yeah*." I'm trying to figure out what to do, whether to dash to the car, when the next contraction comes, she puts one hand on the wall and says, "Call 911 - the baby's coming!"
The next ten minutes are a mad dash of activity. I help her get to the living room couch while her husband calls 911. I can see he's being questioned about me by the operator, trying to explain the difference between a midwife and a doula, so I grab the phone and send him for towels and green garbage bags and a bowl. I get royally yelled at by the 911 operator for having allowed this situation to develop. I keep explaining that I'm a doula not a midwife, that I have no clinical skills and have *not* assessed this woman's dilation. I know the baby's coming because the mother says so, and I've seen pushing before! I finally tell her, very firmly, that regardless of whether the birth is immanent there is no way in hell we're transporting this woman and would they just send the damn ambulance!
Meanwhile, my client is just *roaring*. I've rarely heard a woman make such a powerful noise pushing. I am having no luck encouraging her to pant to slow the birth. At first she would not open her legs and let me see what was going on. (I should add that when she first lay down on the couch and I tried to take her underpants off, she was sufficiently with-it to suggest I just cut them off with scissors!) When she finally opens, I can see a toonie's worth of baby scalp. I look at dad standing by mom's head and ask him if his hands are clean. He looks very confused, so I tell him to go wash his hands. With the next push the baby is born to the eyebrows, while dad stands in the doorway with water dripping from his hands. So I holler at him to come back and prepare to catch his baby. As the head is born, I notice flashing lights through the living room curtains. We try to check for a cord around the neck, but by the time I can figure out what I'm doing, the body is born, sliding into her father's waiting hands. She takes her first breath as a knock comes on the door. I leave the parents and go answer the door to the fire fighters and paramedics. I then run back to the couch and instinctively pick up the baby and place her on her mother's chest and cover them both. This keeps the baby warm against the draft of the open front door, and presents a view to the emergency crew of mother and child as a unit.
The paramedics are fantastic! They never separate mother and child, examining the baby and clamping her cord right where she lies. They administer blow-by oxygen to the baby, not because it was really necessary, I think, but because they felt like they ought to be doing *something*. They sit and chat while everyone calms down. There's lots of laughter. Meanwhile, I catch the placenta in the bowl dad brought. Apparently the paramedics have forgotten about the placenta part. They wait for mom to breastfeed for the first time, and then wait while mom goes to have a shower! Mother and child are finally transported to the hospital, at mom’s request, to be checked out one hour after the birth. The baby rides in her mother’s arms. Baby is 9lb14oz - big! I wish I knew some way of having someone come and check on them at home so that the hospital visit would not have been necessary, but I don't.
The parents are both very excited about what happened. Dad is very proud of catching. I worry that the next day they'll start thinking of what could have gone wrong, and may question why I didn't tell them to go to the hospital earlier. My fears are unfounded, however. They remain absolutely delighted. The mother is convinced that everything wonderful about her child is due to having been born at home. She has become an advocate not only of home birth, but of unassisted birth, after I told her about the interventions that would have happened had midwives been there. It's a little over the top, perhaps, but this has become a tremendous source of strength to her, and testimony to the transformative power of birth. The "my body is strong!" statement is her in the shower 45 minutes after giving birth, after roaring life into the world. Cool.
I'm thinkin' I should carry a few basic "surprise" supplies in future - a couple of pairs of gloves would have come in handy, and some cord clamps and scissors might be a good precaution, although perhaps not without some training in when they’re really necessary. I’m also going to be a little more vigilant with second timers in the future – I’m accustomed to the pace of first babies. The parents are writing a letter of complaint to the 911 folks. :-)
Oh – further interesting fact: this woman had uterine surgery a number of years ago to remove a cyst, so was considered a vbac for her two births. Just so you know. :-)
And as for me, I think I've found a friend.
PS - 24 days later, breastfeeding is going well, and after a moody week or two during which we talked daily and I visited two or three times a week she's coping and stable and her family and friends are telling her how relieved they are at how much better she's doing after this birth compared to last time. She is learning to trust her herself in a variety of ways, and she is processing relationship and past loss issues in ways that do not feel scary to her. She rocks.
***
So now it’s a couple of years later. We’re still friends. In the end she ran into milk supply issues at around eight months, but there seem to be some physiologic reasons for that – I’ve seen some research on the connection between PCOS, obesity, and the late onset of low milk supply. She also sought counselling for postpartum depression in the second half of the year. So, a good birth hasn’t been a miracle cure, but she’s naming problems and facing them head on, which is great, so we’ll take it.
***
If I never really connect with another client, it'll be okay. I've done what I needed to do. I'm a little awed by having had the chance to be someone's catalyst for change. Just a catalyst - the change was in process. But for the rest of my life I'll hear her voice shouting, "Rean! Women's bodies are strong. *My* body is strong!!" I'm so glad I was able to participate in this.
Today she gave me a gift with a tag that read:
With permission comes choice.
And making choices based on what I want
and not what somebody else is telling me,
feels so empowering.
Thank you for giving me permission.
***
A woman hired me for postpartum breastfeeding support with her second child, due in a couple of months. She asked if she could come to me for some counselling to process her first birth experience, which sucked from her point of view. She's a woman of strong moods and opinions, but a lovely person with an engaging personality. She had a doula at her first birth - a friend who was new at it and who froze. It was a bad experience. We’d been talking for several weeks and her due date was upon us. At the last minute, she finally asked if I would attend her birth. I think she realized that her desire to labour entirely alone came in part from feeling there was no one she could trust to really be there for her. She came to trust me.
Among her issues were real problems with breastfeeding last time. Combined with a birth that was speeded up chemically until she could no longer endure the contractions and opted for the epidural she had so wanted to avoid, she had a lot of "my body doesn't work" stuff going on. She experienced postpartum depression that went unspoken of and untreated. At the root of the broken body stuff was growing up as the fat kid in a family of thin, pretty people. At 11 she was on the swim team, playing soccer, and on her first diet. She is now tall, graceful, with luxuriant hair and gorgeous skin. She is also very obese. She has no idea she is beautiful.
She knew she wanted to labour at home as long as possible as a way of avoiding hospital interventions. However, she knew she'd only really feel safe planning a hospital birth as she works with special needs kids, some of whom have special needs as result of birth injuries. She felt she needed the reassurance of the hospital, but was very conflicted about that need.
So, she went past her due date. Her care provider started talking induction. She resisted for a certain amount of time, but agreed to do it at the end of the week following her date. She was prepared to just throw away her natural birth desires in the face of this intervention, with an air of really giving up. Happily, she went into labour herself the day before she was scheduled to be induced. It went off and on all day, and we stayed in touch by phone. I ended every conversation by telling her I was ready to come whenever she wanted me there. She finally called in the evening to say it was getting hard and she needed help. I found her in what I judged to be early labour, contracting hard and fast, q2-3min, but only lasting 30 seconds. No bloody show at all, waters intact. Having a hard time, but talking between contractions.) She had started at 4:30am, so I figured there were many hours to go. Things started to change after I'd been there an hour and a half or so, and I thought we were seeing a move into active labour.
(Vomiting, then into the shower, then back and tearful. Her waters releasing while sitting on the birth ball, clear, still no show. Contractions finally seem to be lengthening a bit. I thought we were seeing the 4cm mini-transition women sometimes experience.)
That would mean we still had a few hours to go. A bit later she says she thinks it's time to go in to the hospital. I've been there for two hours. Her husband gets her clothes, I start getting her up and ready. Then, she makes a funny noise during one contraction, and I look at her when it's done and ask if she was pushing just then. She says something along the lines of, "well *yeah*." I'm trying to figure out what to do, whether to dash to the car, when the next contraction comes, she puts one hand on the wall and says, "Call 911 - the baby's coming!"
The next ten minutes are a mad dash of activity. I help her get to the living room couch while her husband calls 911. I can see he's being questioned about me by the operator, trying to explain the difference between a midwife and a doula, so I grab the phone and send him for towels and green garbage bags and a bowl. I get royally yelled at by the 911 operator for having allowed this situation to develop. I keep explaining that I'm a doula not a midwife, that I have no clinical skills and have *not* assessed this woman's dilation. I know the baby's coming because the mother says so, and I've seen pushing before! I finally tell her, very firmly, that regardless of whether the birth is immanent there is no way in hell we're transporting this woman and would they just send the damn ambulance!
Meanwhile, my client is just *roaring*. I've rarely heard a woman make such a powerful noise pushing. I am having no luck encouraging her to pant to slow the birth. At first she would not open her legs and let me see what was going on. (I should add that when she first lay down on the couch and I tried to take her underpants off, she was sufficiently with-it to suggest I just cut them off with scissors!) When she finally opens, I can see a toonie's worth of baby scalp. I look at dad standing by mom's head and ask him if his hands are clean. He looks very confused, so I tell him to go wash his hands. With the next push the baby is born to the eyebrows, while dad stands in the doorway with water dripping from his hands. So I holler at him to come back and prepare to catch his baby. As the head is born, I notice flashing lights through the living room curtains. We try to check for a cord around the neck, but by the time I can figure out what I'm doing, the body is born, sliding into her father's waiting hands. She takes her first breath as a knock comes on the door. I leave the parents and go answer the door to the fire fighters and paramedics. I then run back to the couch and instinctively pick up the baby and place her on her mother's chest and cover them both. This keeps the baby warm against the draft of the open front door, and presents a view to the emergency crew of mother and child as a unit.
The paramedics are fantastic! They never separate mother and child, examining the baby and clamping her cord right where she lies. They administer blow-by oxygen to the baby, not because it was really necessary, I think, but because they felt like they ought to be doing *something*. They sit and chat while everyone calms down. There's lots of laughter. Meanwhile, I catch the placenta in the bowl dad brought. Apparently the paramedics have forgotten about the placenta part. They wait for mom to breastfeed for the first time, and then wait while mom goes to have a shower! Mother and child are finally transported to the hospital, at mom’s request, to be checked out one hour after the birth. The baby rides in her mother’s arms. Baby is 9lb14oz - big! I wish I knew some way of having someone come and check on them at home so that the hospital visit would not have been necessary, but I don't.
The parents are both very excited about what happened. Dad is very proud of catching. I worry that the next day they'll start thinking of what could have gone wrong, and may question why I didn't tell them to go to the hospital earlier. My fears are unfounded, however. They remain absolutely delighted. The mother is convinced that everything wonderful about her child is due to having been born at home. She has become an advocate not only of home birth, but of unassisted birth, after I told her about the interventions that would have happened had midwives been there. It's a little over the top, perhaps, but this has become a tremendous source of strength to her, and testimony to the transformative power of birth. The "my body is strong!" statement is her in the shower 45 minutes after giving birth, after roaring life into the world. Cool.
I'm thinkin' I should carry a few basic "surprise" supplies in future - a couple of pairs of gloves would have come in handy, and some cord clamps and scissors might be a good precaution, although perhaps not without some training in when they’re really necessary. I’m also going to be a little more vigilant with second timers in the future – I’m accustomed to the pace of first babies. The parents are writing a letter of complaint to the 911 folks. :-)
Oh – further interesting fact: this woman had uterine surgery a number of years ago to remove a cyst, so was considered a vbac for her two births. Just so you know. :-)
And as for me, I think I've found a friend.
PS - 24 days later, breastfeeding is going well, and after a moody week or two during which we talked daily and I visited two or three times a week she's coping and stable and her family and friends are telling her how relieved they are at how much better she's doing after this birth compared to last time. She is learning to trust her herself in a variety of ways, and she is processing relationship and past loss issues in ways that do not feel scary to her. She rocks.
***
So now it’s a couple of years later. We’re still friends. In the end she ran into milk supply issues at around eight months, but there seem to be some physiologic reasons for that – I’ve seen some research on the connection between PCOS, obesity, and the late onset of low milk supply. She also sought counselling for postpartum depression in the second half of the year. So, a good birth hasn’t been a miracle cure, but she’s naming problems and facing them head on, which is great, so we’ll take it.
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