Tuesday, December 13, 2005

"To sleep/Perchance to dream"

I love the drive from a client’s house to the hospital. I’m following my clients, watching the labouring woman’s hand reach up to the roof of the car during each contraction. For me, it’s an in-between time of quiet watchfulness, similar to that “out of time” feeling I remember while feeding a baby in the middle of the night.

Last night, we had a long drive from Surrey to Burnaby General. So, I turned on the radio to CBC Ideas and heard an amazing piece by Jeff Warren called "While You Were Out" about the changes in sleep patterns over the last three hundred years.

References to “first sleep” are present in Renaissance and pre-industrial writings. Only now are researchers discovering that our biological sleep pattern has two main cycles, “first sleep” and “second sleep,” with a two hour intermediary trance-like period, “the watch.”

After sunset, the family would head to the communal sleep space. There would be a quiet period of 1-2 hours rest in the dark, followed by “first sleep,” a deep rejuvenating state. This long wave sleep state would increase the levels of prolactin (ah, the breastfeeding hormone!) After 4-5 hours, people would enter an altered state of consciousness, induced by these high prolactin levels. Any breastfeeding mum knows the timeless trancelike effect produced by high prolactin levels - patient, waiting. In this period, people would traditionally pray, muse on the day’s events, or quietly make love, while listening to the natural sounds around them. Later, “second sleep” would come, full of REM sleep and dreams. They would all wake at sunrise.

This sounds so much like a typical night with a new baby. Hmmm... Rather than seeing the postpartum sleep pattern as unnatural, perhaps we should see this as our return to our natural biological state. Sleeping alone in a room devoid of sensory input seems to be an unnatural state for humans. Our North American need to mold our babies into beings who can sleep alone for long uninterrupted periods is, in fact, altering the delicate hormonal and chemical balance in our bodies.

So, have a quick read of the article, “The Cultural Biology of Sleep,” before delving into Carol Worthman’s research papers, which include “The Ecology of Human Sleep.” You may find some food for thought during “the watch.”

Friday, December 09, 2005


All my previous clients have the correct spelling of my name "Jacquie Munro" and my email address. But doctors who've run out of my brochures resort to scribbling down my name for their clients... Oh, dear, just look what happens then...

Yes, I think it's time to send out more brochures when:
1) Clients try to google my name but have been given the wrong spelling,
2) A client sees an article about me, phones up the newspaper, then has to convince the editor to release my phone number (very resourceful, but could have resulted in the end of the search),
3) Old-school clients look for me in a phone book (no, it's not there!), and poor Jack Munro or Jackie Munroe, etc., still get the odd message about "wanting a doula" on their voicemail, or
4) One potential client googles "Adoula" thinking it's my name...nope...my name is not Adoula Munro.

People can always find me by googling "Vancouver" and "doula", since I'm "Vancouver Doula". Plus my email address is vancouverdoula@gmail.com.

But I still think I'll head down to the printers for some more moo cards...so the midwives and docs can still hand out my cards with the pretty photos...

- Jacquie Munro, Vancouver Doula

Wednesday, December 07, 2005

“Come out of the circle of time/And into the circle of love” - Rumi

In the past, it was the partner’s job, as coach, to time each contraction with a stopwatch. I still have my old list of “...8:27...8:39...8:45...8:54...”from my first labour in 1983. The fixation on time has continued. Now there’s even a program that you can download to your Blackberry which will graph your contractions!

In contrast, I encourage my clients to let go of actively timing contractions at the beginning of the labour process. I think timing contractions is almost too simplistic a gauge of how labour is progressing. It makes you focus on an external reality and lose touch with your inner rhythm, your inner knowledge. It can also make you fixate on how long things have been continuing which, in turn, can lead to frustration or impatience.

Take me for example. There I was, waiting for my first labour to start. I was 10 days overdue. On paper, it looked like I had been in labour for a week. Contractions were every three minutes - sixty seconds long. I thought I was going through the longest labour on record. But I was still able to walk and talk through each “contraction.” I was really just having prelabour tightenings. But my fixation on timing had made me exhausted and mentally drained even before the true labour began. If I’d been able to talk with someone a few times a day during that last week, someone who understood the logic of the body and the rhythm of labour, I might have been able to rest more, and been more emotionally capable during the true labour.

Now, when I’m working as a doula, I try to help people deny the niggly prelabour stuff. If you think of the early symptoms like the start of a period then you may be able dismiss the first signs of labour (the “forget it” stage). Sure, we talk on the phone during this period, but you certainly don’t need to time anything. If you only attend to the active part of labour, where you can no longer deny it, it will feel like your labour is shorter. (Like a client this year who denied things so beautifully throughout the day that she asked me, "Do you really think I'm in labour?" when I arrived at her house. It was only 5 hours later that her first baby was born.)

Now, I watch the momentum of labour, the woman’s movement, her face. Is she flushed? Are her knees bent? Is she rising onto her tiptoes at the peak of a contraction? How much clothing can she stand to wear? What sounds is she making? All these things tell me how her labour is progressing. But I’m not the “keeper of the wisdom.” In prenatal visits, I share all these secrets with clients.

I just love it when I get a phone call from a dad..."Uh, she’s doing that thing you showed us on the chair. The contractions only started half an hour ago, but I think we should just meet you at the hospital." I can hear her low moans in the background. It’s so great to know that he “gets it,” and hasn’t had to rely on timing contractions to determine the fast progress of her labour.

If you truly MUST write down the contractions (for the baby book), do it. It can be a fun way to keep busy during early labour. But it’s only good at showing you exactly when active labour starts. When does that happen? Well, the moment a woman says, “Put that pen down and rub my back!” she has reached the start of active labour. Oh, and another great indicator of the beginning of active labour is to play a game of cards. I was at the hospital with a woman who was being induced. “When will I know that it’s REAL?” she asked. “Well, when you throw your cards at me,” I said. It was only another half hour later that she threw the cards down. “Now, I know what you mean,” she laughed, as she jumped out of the bed. Ahaa! She had entered active labour.

So, here’s a great way to access your instinctive side: Take off your watch, turn all the clocks around... and feel the rhythm of contractions. For example, you can lean on the kitchen counter for a contraction, then pick a walking circuit around the house. You might have to walk three circuits before another contraction comes. After an hour, you may only be able to complete two circuits before the contraction comes again. You will know “in your body” the rhythm of labour, and won’t need to focus on time any more. Once you are able to flow with the labour, this will encourage a trancelike state (ah, endorphin release!), and help you go deeper into labour. But, always remember to keep in touch with me and your midwife or doctor. Oh, and we’ll know that it’s time to go to the hospital when you can’t walk another circuit (I will certainly be with you by that time!)

Every labour is totally different. Some women follow the textbook and have contractions which increase in length, strength and frequency. Other women can have contractions which are fast and furious from the first contraction. On rare occasions, some women find that their contractions are “pokey” all the way through. Labour is not a linear process; it ebbs and flows as the body and your baby requires. I will help you navigate this rhythm. When I talk to you on the phone, I will be thinking about how many times you have to stop talking (i.e. have a contraction) within a 10-minute period. In early labour there might only be one contraction every 10 minutes. Generally, in active labour, 3-4 contractions will occur in each 10 minute period. But the sooner you can let go of time, let go of your “thinking brain,” the sooner you will experience the timeless rhythm of labour. You will be able to cope much better.

So, I encourage you to trust your body’s rhythm, drawing guidance from your chosen caregivers. Talk to your doctor or midwife in advance about phone contact in early labour. Remember, you’ll be talking with me on the phone A LOT in early labour, and I will come whenever you need me. My arrival isn’t based on time, but on your need for extra support. Or your partner’s need for support! Then...I’ll be there.

Friday, December 02, 2005

Helping mothers open the door to life

Journalism students at Langara College produced eight weekly issues of The Voice newspaper. As a final test of endurance the pressure was ramped up and in the ninth week they produced four daily newspapers. Adam Johnson's submission made the top story in "The Best of the Dailies!"

“A 65-year-old midwife held my foot and she didn't move. Then she would look up and she'd smile. And I thought, obviously things are okay.”

“I just said, I need to do this.”

The deep kindness in her eyes grows determined as Jacquie Munro, 45, describes the day she found her calling. She was inspired by her second birth to share this positive experience with others. That was 18 years ago.

“It altered who I was radically,” she says. “I wanted to change people's lives the way they had changed mine.”

She began working as a childbirth educator, but when her students kept having difficult births, she decided to guide the next batch through the process first-hand. Eventually, it became a fulltime job. While she initially called herself labour support, the word Doula came into use in the early 1990s.

Doula is a traditional Greek word referring to an experienced woman who helps other women through childbirth. In its modern connotation, it is someone who counsels the mother before, during, and after childbirth, without actually birthing, or “catching” the child.

It is a job of simple acts, small gestures, and one hell of a lot of work. “It's often just eyes and hands—and just one word,” she says. “I just say, you are safe.”

On her kitchen table, Munro looks over a huge stack of file folders, each representing one of the 602 lives she has helped into the world. “God, I've been doing this a long time,” she says, smiling at the size of the stack.

She says the most important thing she does is provide continuity of care, by being there for the mother during the entire birthing process.

She says this continuity is sorely lacking in the current health care system, where mothers often deal with overworked health care workers.

Munro acts as an intermediary between the mother and the health care system, arranging the trip to the hospital, consulting with doctors and nurses, and maintaining a safe atmosphere for the mother.

“In births where there isn't anyone looking over the mother, a woman's autonomy can be lost completely,” she says. “You become a patient, which is usually very submissive.”

Munro seeks to create an atmosphere and mindset where a mother can get into the “birth trance,” a state of surrender and acceptance that allows the childbirth to proceed naturally. “It's completely analogous to lovemaking,” she says.“You cannot surrender to the process unless you are safe.”

But Munro insists the labour stage is the least of her concerns, pointing to staffing shortages at hospitals and the limited availability of rooms and medication. She is also concerned with the recent trend towards cesarean sections in place of natural childbirth because of the serious health risks associated with this procedure.

However, when necessary she uses all the tools of modern-day childbirth. “Labour pushes you to the very edge of what you think you can do, but it shouldn't be torture.”

After hundreds of births, Munro still finds profound meaning in the experience.

“When I'm in there with people in birth, it's like the door between life and death is wide open,” she says.

Munro presents a happy and vibrant personality, and demonstrates the limitless patience of someone who spends days massaging backs and easing nerves.

But there is a deep, underlying fatigue associated with work that requires such an emotional commitment.

“Last week I did three births in two days. I had four hours sleep in 64 hours,” she says, smiling. “But it's great.”

by Adam Johnson
Langara Journalism Student (Certificate Program)