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.

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.

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.

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.

Six degrees of Lucina

Lifted from Doulicia, with thanks.

Start at your own blog site. Select one of your blogroll links and click to it. That is click 1. Then select (preferably at random, without even trying to deduce the subject matter) one of that blog's featured blogroll links. That is click 2. Repeat this process and see where you are by your sixth click.

I have discovered Angry Angry Steve. I am amused. I am particularly amused by the CNN screen capture from Late May. Steve, oh Steve, why so angry?

PSA

Wimmin -

Either clean up after yourselves, learn to aim, or sit the hell down. Please! There's no excuse!

That is all.

Living On Call

Over the years I've heard many doulas talk about things they do when they're on call - how they live their lives, what rituals they perform when they're anticipating a birth. Many doulas do this work part time. Many are married women with spouses who support the family, or substantially so. A few have other jobs and do births here and there. Doulas who do a handful of births each year sometimes have an "on call" period, typically two weeks on either side of a woman's due date when they guarantee their availability. So, there's a clear division for them between on call time and off call time.

I'm a full time doula. There is no such division in my life, and that's a problem sometimes.

Honestly, I've never really understood the concept of the on call period. I've had enough clients go into labour before 38 weeks that I wouldn't dream of going away for the weekend, for instance, when someone is 37 weeks without having their knowledge and approval well ahead of time and having backup in place. I've chanced it the odd time when I've had a month with no due dates - I've gone away for a weekend right after the last birth before a break. But it's hard to enjoy those breaks because it means I'm going to have trouble paying bills that month. But I digress...

What this means is that I've mostly lost the sense of anticipation that comes with being hyper aware of being on call. It's just how I live my life. This means that all other plans are subject to cancellation. We go to concerts and events, but we no longer have a symphony subscription because we were just too likely to miss evenings.

For quite awhile I was very cautious about alcohol use, but I've loosened up on that one. I tend to stick to just one glass of wine or one beer, however. It's not that I'm making any life-or-death decisions - I'm not a brain surgeon - but just because of the way it smells. Pregnant women sometimes have incredibly sensitive sniffers.

Whenever I start up with a practitioner who charges for missed appointments, I explain that I live on call and that I may need to cancel without providing 24 hours notice. I'll call and leave a message in the middle of the night if I'm on my way to a birth and I've got a morning physio appointment, for instance, but that's the best I can do. So far, everyone's accepted this and I haven't been charged for missing things. So far.

I do not cancel life and sit by the phone when someone's due date is close or has passed. I understand the new doula who finds it difficult to sleep when a client is close, but you can't live that way. Eventually the novelty wears off and it gets easier. I don't even cancel life when someone's in early labour anymore. Birth is unpredictable, and I often get to go to an interview, teach a class or attend a dinner party between the first "heads up" phone call and the "you need to come now call. I have a pager and a cell phone, so I carry on until I actually have to leave.

The cell phone is always charged. There are extra batteries for my pager in my purse, in my birth bag, in my desk and in my bedside table. (An aside: Why do pagers always, I mean *always*, start doing their chirping death dance in the middle of the night?) I live in a big city with 24 hour gas stations, so I don't worry about making sure the car is full at all times. Putting in ten bucks worth of gas really doesn't take very long these days, you know?

I do tend to have my birth bag and cd player in the car all the time. I don't think I've ever been called to a birth where I had to worry about going in inappropriate clothing because of not having time to change. Usually I'm at home when I get the call to come - because most of the time that's during the night. Babies like the night, the little dears! However, I have a couple of t-shirts in my birth bag and I could always ask to borrow a pair of scrub pants at the hospital if it were desperate, I suppose. I don't wear a lot of girlie shoes (with the occasional exception of something like The Red Boots ), so that's unlikely to be an issue. When I'm working with my contractor sweetie on a job site I usually have a change of clothes with me. I can do a birth in almost anything, but stained workpants and steel toed boots really aren't going to cut it. If I'm home then I wear my Crocs and a particular necklace for luck (yes, really, I know), but I can live without them.

Some doulas take two cars when out with their families when they're anticipating a birth. I've only done this when I've actually received a heads up call and I know there's a strong likelihood of having to go and leave everyone else behind. Otherwise they drop me at the client's home or at the hospital, or I take a cab, or the kids take transit home, or whatever seems easiest at the time.

It's just life.

It is hard, though, to be aware of this in the back of your mind all the time. I feel guilty if I stay up really late, have an extra drink, or god forbid get out of the house without my pager. (Actually, in the last instance I've been known to call home and get one of my kids to wear it so they can call me if it goes off.) And it's really hard to not be able to go anywhere. My sweetie loves camping, and although he doesn't get to do it much, summer being his busy season, he'd like me to come when he does get the chance. For that we'd have to go to some lame campsite just barely out of town and we probably would have to take two vehicles.

When I have a holiday or a conference or some such in the future, I tell potential clients about it at our initial interview. When I have a weekend out of town within a couple of weeks of a woman's due date I usually don't get the job. For my annual two weeks off in the summer I keep five or six weeks free of due dates in order to minimize the chance of missing someone. But each summer for the last three years I've had a client go into labour while I was at the cottage. It sucks to miss a birth. I have two repeat clients that are due within two weeks after my cottage time this year. I just couldn't say no because they're repeats, but they're going to have to meet the backup before I leave because I'm *not* racing home from the cottage for anyone this time. One year I found myself actually wearing a pager at the cottage because a client really wanted me, not my backup. One year I went a day late because someone went into labour the evening before I was supposed to go. This year I'm taking my two weeks come hell or high water!

I've been toying with the idea of taking one week per month off call, and making that part of my contract. If I just told families that I'm off call the third weekend of every month, or something like that, I could get some time to clear my head and shake off that on call awareness, as well as time to get drunk and stay up all night snogging. But I'm worried that clients wouldn't like it. Do any of you doulas or midwives do anything like that? Does it scare off clients? Do they use the backup if they need to?

Sigh. Apparently I'm going to use this blog to process things that are frustrating me. But I can be funny, too! Just wait! Really!