Wednesday, November 30, 2005

On Memories

"So much of our early gladness vanishes utterly from our memory: we can never recall the joy with which we laid our heads on our mother's bosom or rode on our father's back in childhood; doubtless that joy is wrought up into our nature, as the sunlight of long-past mornings is wrought up in the soft mellowness of the apricot; but it is gone for ever from our imagination, and we can only believe in the joy of childhood."

George Eliot, Adam Bede

Conscientious parenting begins before our children are born. Writing a pregnancy and birth journal can help to create wonderful memories for our babies. My own children loved it when I read my journals aloud at bedtime.

Sarah would ask, “What did you do before I was born?” She was fascinated to hear about what daddy and I had done in those weeks of waiting in the August heat. She loved hearing that she had tried to forge her own path out of my body. "You wanted to come out facing forward, so you wouldn't miss seeing a thing! But you finally spun around and came out with a splash!"

“Read the part about how I peed all over you!” my four-year-old son would laugh. Then I read to him, “The midwife told me to open my eyes and look down. Someone held my head and helped me to curl around my tummy as you tumbled out onto my leg. You were so heavy and slippery. Then you peed - so hot! - up my body. And we all laughed! And your daddy cried as he called out - It’s a boy! We couldn’t believe it. We were sure we were having another girl. Then we said your name - Alexander.”

These stories are like family rituals, forming a strong core onto which all the other family memories bond.

“You say you want a revolution/Well, you know/We all want to change the world"

“Crisp and non-preachy” is how John Lennon’s Revolution was described on the radio today. After almost 40 years the form of the message is still unmatched. What would John Lennon have said about the social and political climate in 2005?

I think I’m pretty clear on what he might have said about George Bush and Iraq. But what would he have thought about the “Britney Spears School” of birth? Would he have commented on the “Too Posh to Push” scene? Would he have questioned why women seem to be so scared of their bodies?

This evolution (devolution?) in birthing practices seems to be leading us towards the world portrayed in 1984 or The Giver. How do we call for a change, a revolution, in the birthing world, without sounding preachy? How do we stop the l
oss of “normal birth?”

These questions made me sit down today to check out my 2005 stats. I needed to look at them to see how many “normal births” I’d attended this year. I’m so pleased that, out of the 79% spontaneous vaginal births, 61.4% of my clients had simple no-fuss births, and only 3% had unexpected cesareans. So I think you can say I’m part of a revolution against the “Too Posh to Push” tide, one woman at a time. And don’t think that my clientele is skewed towards young “low-risk” women. The majority (56%) of my clients are over 36 (10% of which are over 40).

What I do isn’t about the stats AT ALL . My aim is to help each woman forge a memory that is positive and empowering. There is no judgement against the women who need cesareans or epidurals, forceps or inductions. Actually some of my clients who have very difficult, intervention-filled labours are the most empowered by their experience. But I try to keep things as simple as possible for everyone, to ensure the smoothest transition to parenthood. My greatest joy comes when I hear, “If I can get through labour, I can achieve anything!”

When I hear that, I know we can start a revolution...

70 births so far in 2005

Spontaneous Vaginal Birth 79% (55)
Assisted Birth 5% (4) (1 vacuum, 3 forceps)
Cesarean birth 16% (11)
13% Booked (7 breech, 2 sets twins) (What's with the 10% breeches?)
3% Emergency (1 fetal distress, 1 transverse arrest at 10cm, both w/previous epidurals)

Simply Straightforward Birth (i.e. No intervention, no meds, excluding nitrous oxide or TENS) 61.4% (43)

Epidurals for Vaginal Births 21.4% (15) Reasons: 4 to stop early involuntary pushing (1 resulted in vacuum), 1 hernia pain, 1 prophylactic for low platelets (w/no further complications), 3 for pain (2 resulted in forceps), 5 with oxytocin induction/augmentation, 1 for forceps (baby to SCN)

Place of Birth
Hospital Births
93% (65) BC Womens (51) (1 diverted from St Pauls), St Pauls (11), Lions Gate (2), Royal Columbian (1) (diverted from BCW)
Home Births
7% (5) (4 planned w/midwives, 1 unplanned w/paramedics!)

57% (40) Family Practictioners
34% (24) Obstetricians
9% (6) Midwife

Client Age
20-29 11%
30-34 33%
35-39 46%
40+ 10%

- Jacquie Munro, Vancouver Doula

Tuesday, November 29, 2005

“There’s snow! That means it’s winter, so the baby must be coming!” paraphrase an excited older sibling (age 4) this morning...

So cool that her logic worked so well. Mummy and daddy have said for 9 months that the baby will come in the winter. It snows in the winter. Today it is snowing. Therefore, the baby must be coming today.

And the baby came. What a drive through snowy streets to the hospital! What joy to find that my client had already surpassed her last labour’s dilation! What a triumph for her to labour without intervention or medications (other than nitrous oxide gas - which doesn’t count, right?) and birth (with under an hour of pushing) a glorious 9lb 1oz baby girl!

This VBAC (vaginal birth after cesarean) was the talk of the hospital today. Congratulations!

- Jacquie Munro, Vancouver Doula

Monday, November 28, 2005

Mail sampler (to encourage new mums)

Dear Jacquie,

Sam is 10 months old now, and doing really, really well. She is a very mellow, happy baby (and she sleeps through the night which makes life SO MUCH EASIER).

My birth experience has stayed close to me through everything - to be expected, I suppose, but it has become a memory that I draw on when I'm having one of those tough days (i.e. not enough sleep, Sam teething, Sam not eating her peas, all of the above in combo with PMS - I *so* didn't miss my menstrual cycle...). My memories are overwhelmingly positive, and much of that has to do with your calm presence throughout. You set the tone, you guided me to that place where I knew that my body would - and could - do what needed to be done. That strength and confidence has made all the difference, particularly during the early months when everyone around me seemed to think they knew what Sam needed better than I did; whenever I've had doubts, I've gone back to that basic trust in my body, and it has so far given me the best advice.

My trust in my intuition, and in my body's ability to take care of itself and my babe, is at the very core of my mothering. I think that your guidance through the birth helped me find that - and for that I thank you. I hope you're available when we do this again! I'm really looking forward to it. How weird is that? I must be ovulating... ;-)

I hope all is well with you and yours!


Sunday, November 27, 2005

“In and out like a fiddler’s elbow”

I laughed when I heard this expression on CBC radio this morning. It’s supposed to mean that you’re really busy. Well - that was me this week. It had started out quietly...

And then...

Three births in two days. But the crazy thing is that I didn’t get more than four hours sleep in 64 hours. People said I looked alert and I felt fine the entire time.

I know that if I’d been at only one birth I would have fallen apart. But attending three births, each with their own special atmosphere, flavour, challenge and fun, seems to be what made the difference.

Challenging and fun it was!

It all began with another day of diversion at BC Women’s Hospital. Funny word “diversion.” The dictionary definition is “an activity that diverts, amuses or stimulates.” Hah! Yes, it is certainly stimulating when the hospital is on diversion. In hospital-speak, diversion is when the hospital cannot accommodate a patient. That’s just fine when it’s a general hospital. You just wait. But labouring women can’t just wait. You get sent, or “diverted” to another hospital. On Wednesday, my client was sent to Royal Columbian Hospital. The next patient after her was sent to Ridge Meadows...the next to Victoria. It’s too upsetting to think about those other women.

Luckily, once my client arrived at RCH, she was given the top birthing room. She dubbed this “The Las Vegas Suite” because of the oversized bathtub smack in the middle of the room. Details aside, this was an amazing birth. She showed such strength and power, trusted me when I said “You are safe,” and pushed out a glorious 9lb 11oz baby boy.

When I returned home on Thursday at dinner time, I didn’t go straight to bed. I wanted to enjoy the evening. How silly of me... I was out again by 11pm, heading for a home birth. I was relaxed. I knew there would be no emotional struggle against the system, no worrying if there was room at the inn. We just had to honour the flow of labour.

Well, there was one moment of anxiety when my client worried that the baby might be born before her older child woke up. No need to worry, though - we had tucked her and the new babe into bed, cleaned up the house, and driven away before her daughter ran into the room. What a morning of discovery for the family!

Then, when I’d only been asleep for two hours...

The pager vibrated off my bedside table. A client needed an emergency induction. The self-described “pessimistic” obstetrician held out little hope for a vaginal birth. But, after only 9 hours of active labour, and “optimistic” heroics supplied by the family practice doctors, my client greeted her gift of a lifetime - a wide-eyed son. Not a small feat for a 43 year old single mum who had hardly dared to dream about this day.

I drove home at midnight. The nurses called out to me as I left the building, “Drive slowly!” “Be careful!” “Keep the windows down!” “Sing loudly!”

I thank them all for their care.

Dawn Streetlamps

there is something beautiful
about the sight of three midwives standing outside
at dawn
under the halo of streetlamps
sifting through the night's events

a neighbour leans out of a doorway
Have they had the baby yet?
Is it a girl?
We can't tell you!

laughter as they drive away
the tires shushing on wet roads

- Jacquie Munro, Vancouver Doula

Tuesday, November 22, 2005

"Take no advice...follow your own instincts...use your own reason, to come to your own conclusions" - Virginia Woolf

This week is shaping up to be “postpartum visit week.” Lots of wee boys (and their tired mums) to visit. I’ve also heard from clients whose babies range in age from three to eight months. We’ve discussed everything from sleep deprivation to “what the poo should look like.”

The major issue this week isn’t (thankfully) breast-feeding. Pretty much everyone is doing well and producing abundant quantities of breast milk. One client is even donating her extra milk to the Children’s Hospital Milk Bank, (604) 875-2345, ext. 7607. Another just phoned to say that, with the help of Renee Hefti-Graham (604-733-6359), her little girl finally latched successfully at six weeks and is doing so well! All the other babies are latching well, gaining weight, sleeping (at times) and peaceful (at times).

What seems to be causing anxiety this week is the overwhelming contradiction between a mother’s instincts and outside influences. Books, family, friends and complete strangers are undermining the mothering instinct for so many of my clients.

A client of a one month old was doing “just fine, thank you very much” until her sister gave her a book advocating strict scheduling of feeding and sleeping. After trying the suggestions for a few days, her baby was up every hour at night and no one was getting any rest. I asked her what her instincts told her to do...and she said, “To feed him when he wants, or when my breasts need relief, to pick him up when I feel like it, or when he cries, to carry him about, talk to him - whatever just feels right. But my family keep telling me that I’ll spoil him, and I find I’m second-guessing myself. It’s making me crazy!” Sounds sadly familiar...

Another client whose baby is three weeks old remembers being told to feed her baby every three hours. She found herself resisting the urge to feed her baby when he started crying every hour. Classic “three week” growth spurt symptoms! The baby was demanding more time at the breast in order to increase the mum’s milk supply. The only reason she resisted the urge was because of a comment made by the visiting health nurse weeks ago. Not trusting herself and her baby was leading to anxiety and conflict.

“But I just fed him!” is the common cry. Well, think of him like a 16 year old boy in the middle of the biggest growth spurt of his life. You’ve made dinner (which he wolfed down), and then, only an hour later, he’s hungry again! So he orders in a pizza. Then he miraculously grows 6 inches in a few months. Ahaa!

Newborn babies are just like that 16 year old boy. Their feeding patterns will vary from hour to hour and day to day. Sometimes they’ll pig out from 6-10pm (cluster feeding), and then the next afternoon they’ll sleep 3 hours. Problems only seem to arise once we start to throw our Type A controlling brain into the mix and start to analyze things. “Hmmm...let’s see, well, he slept three hours after we were out all morning, so I should try that again.” No luck next time... Just like living in the moment works well in labour, so it works in the postpartum period. The newborn baby will be a changeable being every day. Trying to discern patterns in his behaviour during the newborn period is a futile attempt at control. Oh, and you can’t spoil him at this point.

When I had a newborn, I always reminded myself “to think like a cave woman.” No clocks, no books, no scheduling, no “shoulds.” I turned the clocks around so that I wouldn’t be able to remember how many times I was up in the night. I allowed the passing of the night to become fluid, a zen time of quiet movements and silent feeds. I threw away the hospital feeding / voiding chart and tried to pretend that this was my fifth child, and that I had faith in my body and my baby’s ability to work well. I threw away the bra pin - the one that was supposed to remind me which breast was next. I would gently “weigh” a breast to determine where my baby needed to latch (have him take the heaviest!). I would read novels and poetry and children’s books aloud during each feed. And if I continued to hold the baby in my arms between feeds, just for a little more quiet, and a good read for myself, then I wouldn’t feel guilty. And if I needed to turn on the fan or the vacuum cleaner, or dance around with my baby in my arms just to soothe him (every night), I didn’t think we had a problem. I just accepted it as necessary in that moment. And if I had to head out for a drive to UBC and back (all the while listening to CBC Ideas) just to settle an especially cranky little one...and then woke the baby while tripping up the stairs...I’d just laugh and ask my husband to do the rounds again.

Sure, there are mornings when you wake up and you feel less rested than when you went to bed. There are days when you sit all day at the computer, reading the UBC calendar, just to see what you could have been doing if you hadn’t had a baby this year. And sure, there are nights when you crumple into a sobbing heap because that sweet little baby STILL hasn’t fallen asleep. And there really are nights when you wonder what you were thinking having a baby! That’s when you need to gather all the amazing people around you who REALLY support you, who won’t undermine your instincts, who will tell it like it truly is, and still be there to help - without judgement or advice.

What you need is a group of like-minded souls who honour motherhood. So, give me a call first, then start attending mum’s groups, even if you think your baby is the most colicky baby possible. We will understand. I will remind you of the strength you showed in labour, how hilariously out of control this all is, and that you are at the beginning of an incredible learning curve, so you need to be gentle on yourself. I will remind you that your baby is like no other. Your little family is like no other. You need to find your OWN way through this parenting maze without judgement or expectation - and yes, it will be a roller-coaster for a while. You will arm yourself with friendship, laughter, music, dance, walks and sleep whenever you can find it. Then you will gradually slough off your old Type A controlled existence (ah, such a challenge) with as much grace as you can muster. Together, we will help you to build up your confidence, and build strong boundaries about your new family, so that inconsiderate remarks and unwanted advice don’t undermine your fragile world.

And at six weeks, or three months, or at eighteen will be at a point where you can say. “Wow, that was a ride!” But, supported by all those around you, you will have made it to a place where you might even think about doing it all over again...Then, Hey - call me!

Tuesday, November 08, 2005

Intuition, Trust and Red Flags

It’s funny how, over the years, I’ve only been given the births that I can handle. Each birth prepares me for the challenges of the next. What amazing gifts these women give to each other.

When I began my life as a doula, I was still breastfeeding my one-year-old son. I knew that I could only manage six hours away from him. For me - I couldn’t stand the breastmilk backlog! For him - hey, he needed me. For the first year, the births were amazing. I was never needed for more than six hours. I was only faced with long births once my son was able to go longer between feeds. Though I do remember pumping midway through long births for a few years...

Each birth has taught me an amazing lesson. For example - the very first birth I attended as a solo doula was a 4 hour vaginal breech birth. Being a new doula, I was nervous about the possible challenges with this birth - I’d read my medical text books! But my client was unperturbed - she had been born breech herself. So, when she went into labour and her husband was nowhere to be found, she called to say we should meet at the hospital, then called her doctor and asked him to pick her up on the way. Then she actually made the doctor take her through McDonald’s drive-thru so she could pick up a Big Mac! “Why not!” he said. Well, that baby came so easily and swiftly. “It wasn’t as bad as a rowing workout!” said my client after that baby was born. Wow! That was my first lesson in trusting the client.

At that point, I realized that our internal knowledge is strong. My client’s birth had gone smoothly because she wasn’t concerned for her or her baby’s safety. She wasn’t being irresponsible or foolhardy either. She just totally trusted her body to work well. I believe she would have had a sense if something was wrong - and would have acted on it. That’s just the way things work. Problems only arise if the woman’s intuitive sense is blocked, or if she is forced to second-guess herself. That results in fear, which further complicates matters. But those are things that we discover during our prenatal visits.

You might argue that we can never anticipate when a medical emergency is going to happen - that some emergencies come out of the blue. Well, yes, sometimes the course of a labour can change in a moment. But it is never without warning signs. The problem is, women’s intuition is not being honoured, and caregivers aren’t continuously with the woman, and miss the warning signs. As an experienced doula, sometimes I’m the only person who is consistently there, knowledgeable enough and detached enough to see these warning signs.

I was with a woman in labour at St Pauls. On paper, things appeared to be going well. She was at 5cm, unmedicated, had intact membranes, and was rocking back and forth on her hands and knees. But she was worried. She kept having images of the baby pushing his head out of the pelvis. The staff were busy with the shift change, laughing and joking. The new doctor on shift, who I know well, asked if I had any concerns. I went into the hall with her, and told her about the woman’s image of the baby. I also told her that I had a very strong intuitive sense that something was wrong. I “felt” a bad odour coming from the woman. The smell was so subtle, but ominous. The doctor went back into the room and couldn’t smell anything odd. I said I just knew that something was different, that I couldn’t shake the bad feeling that I had. The doctor stayed in the room for the next hour, monitoring the woman’s contraction pattern by using her hands, listening carefully to the baby’s heartrate. After an hour of seeing the baby’s heartrate climb, she asked the labouring woman what she thought - intuitively. The woman looked at her doctor - “Intuitively? I think I need a cesarean. But that’s crazy, isn’t it?”

“No, we’ll do it,” said the doctor, “I trust women’s intuition.” And, yes, you guessed it - the smell in the OR was terrible. My client had a massive uterine infection. I was right, I had smelled the change in her body. And the woman’s sense that the baby didn’t want to come vaginally, that he was pushing away from something, was correct. The mum and baby did very well after the surgery, but it had been a close call.

Babies are great with red flags. They madly wave those red flags. Our problem is that we often don’t recognize what the baby is doing. When we trust our instincts, and listen carefully to what a labouring woman is saying, we can learn so much more than is available to us through vaginal examinations or heartrate monitoring.

Think about how often the baby’s heartrate must dip during pregnancy. If mum lies in such a way that the baby’s umbilical cord is compressed, the baby kicks up a storm, mum rolls over, all is well. If mum is sitting in a deep sofa, which the baby finds uncomfortable, she’s forced to stand up and stretch. During pregnancy, we hardly realize all the things that we do in a day in response to the baby’s needs. We dance with our baby throughout pregnancy, an ongoing interplay. We keep our baby safe.

One woman in labour kept saying that she had an image of a rock climber, with the ropes wrapped around his chest, one hand on the taut rope on the rock wall. Her husband laughed and said, “You’re remembering our first date!” “No, it’s an insistent current image,” she said. She reached full dilation and started to push. Every time she pushed, the baby’s heartrate dipped (sometimes that’s an encouraging sign, sometimes it’s not...) Well, after three hours, the baby hadn’t descended at all. In fact, the baby had popped out of the pelvis. The obstetrician said his classic line. “That baby’s not even in Vancouver! He’s so high, he’s in New Westminster!” My client talked about her image of the rock climber again, and agreed to a cesarean birth.

Well, guess where the umbilical cord was? Wrapped around his chest like a rock climber. And he had his right hand clutched onto the taut cord, just like his dad had done on the first date. The couple laughed and laughed, feeling great about their decision. “I’ll trust you next time,” said the dad.

I’m so thankful for the lessons I have been taught by my clients and their babies. I have so many examples of how trusting a woman’s inner knowledge, trusting the baby’s red flags, and being continuously present, can positively affect the outcome of a labour. Women are empowered when their inner knowledge is honoured. It makes them more confident and results in joyful parenting.

But I’ll dole out the stories slowly. It’s time to call a new mum and have her teach me some more...

- Jacquie Munro, Vancouver Doula