Thursday, June 08, 2006

Taking Stock (or living in a bubble)

It’s good to take stock of things every once in a while. Change happens so gradually that you often don’t notice until you stand back and observe the differences. Strangers are often the first to notice changes in our children. When did my daughter change from looking like her father, to looking like me? When did my son get taller than his sister who is almost four years older than him? Somehow I missed seeing the changes in the moment.

It’s the same regarding birth practices.

When I started working as a doula, shaves and enemas were still routine. Women were given IVs, and continuous monitoring was deemed necessary. Women still had to write militant-sounding birth plans in order to achieve their goals during birth. Informed consent and family-centred maternity care was a goal, not the norm.

Now, it’s only old books on library shelves (or U.S. television?) that perpetuate the myth that these practices still exist here in Vancouver.

Maybe I live in a bubble...but things have changed here in the hospitals over the past 20 years. Monitors aren’t routinely kept in birthing rooms. I rarely see IVs given without cause or consent, and the nurse is the first person to suggest “more juice so you don’t need an IV.” No one looks at me oddly when I shake my client’s hips or help her to squat. The doctor will do everything in his or her power to prevent a woman from tearing. The nurse and I can be so in harmony that we communicate with only our hands and eyes, and guide the labouring woman into the bath. The doctors and nurses now hire me for their births. No one seems to remember how to do an enema. The dad and family are welcomed with open arms. Pretty much everything that women used to include in birth plans are now accepted as normal practice (so we just don’t write them any more). Prenatal classes include more birth art than breathing. The nurse might put aside her paperwork, take photos lying down on the floor, and cry along with the family. The labouring woman and her family are truly at the centre of this new type of care.

Long gone are the scary matrons of old. Now, I know that the charge nurse will encourage my client to stay at home as long as possible. At the hospital, she will take my client’s blood pressure twice...then wait...calm her down...three times...until she gets a low enough reading to allow admittance to “the fancy rooms.” I know that if I don’t see our nurse for a while, she’s busy trying to advocate for my client. I know that if I get a hunch that something’s not quite right, the nurse will listen to me and take immediate action. Together, we have prevented many complications.

I’m lucky that most of the doctors and midwives that I work with have recommended me to my client. I know that I can call them at any time with concerns or questions. They also call and email me an equal amount. It’s such a seamless and collaborative process that I never noticed when it reached this level of cooperation. When did we grow up?


Anonymous said...

You are indeed blessed.

Anonymous said...

You surely are blessed to work in such an environment. How did this change come to the hospitals in Vancouver? We are so far from this in the US.

Jacquie Munro said...

I wrote that comment about 18 months ago. Everything I wrote is still true...but we're now experiencing overflow problems, lack of staff, etc. It can be quite a challenge still, but for different reasons. I asked the head of the assessment room how we can keep birth low-key and she answered..."Do what you do, and keep them home until fully." So, we're still having to "circumnavigate the globe" before going to the hospital. I guess it will never be perfect.