Friday, June 29, 2007

Grace and Beauty

'All things of grace and beauty such that one holds them to one's heart have a common provenance in pain.'

Cormac McCarthy

Thursday, June 14, 2007

Well, that was quick...700 is here!

Faster than a speeding bullet...well, not quite...

Client #700 has had her baby! The birth was powerful, beautiful, joyful, challenging, and quite unbelievable for mum. Her first labour was more than two days...this one was only 5 1/2 hours.

And that wry sense of humour that I wrote about in the post from earlier today? This little girl decided to come sunny side up! Easily, too!


To epidural or not to epidural...

That is the question...

I had two back to back calls the other day, regarding epidurals. The first was a last-minute possible client who called to say she wasn't going to need my services after all...because she'd just had her baby that morning (in very short order). She was quite surprised how quick and simple birth was - surprising since, as a family doctor, she'd been attending births for some time, and had anticipated...well, something more hellish than she encountered. She said she now understands that the decision to have an epidural isn't one that can be made before's all about responding to the needs of the day.

The other call was from a woman interested in hiring me as a doula. She had read my "Statistics for the Utterly Confused" and just wondered if I had an agenda to eliminate epidurals (since my client epidural rate is significantly lower than the general population). Um...nope. My clients who labour without epidurals aren't self-flagellating ascetics or martyrs (as TV may have you believe). They are women (with the help of a doula and doctor/midwife who trust in birth) who happen to have straight-forward normal births, and then say, "Hey! I didn't even think about meds. Interesting..."

A smooth and simple birth requires you to be present, conscious, and conscientious on the day of labour. In that mindset, you will make the right choices, and use the necessary tools for the day, simple or otherwise. Most days, all that's required to help a woman give birth are love, eyes, ears, hands and wisdom. But, if the day throws some major "curveball" at you, then a few more tools (including an epidural and more than a pinch of pragmatism) might be required.
- Jacquie Munro, Vancouver Doula

Putting the Vancouver in Vancouver Doula

I'm going to have to time the ride to be more precise, but the trip from Vancouver Doula's new home to either St. Paul's or BC Women's Hospitals takes about...4 minutes.

Add that to the fact that the majority of my clients will now live within 15 minutes of me...and the result will be even better care.

I'll be able to pop over to check on clients having long prodromal labours, do emergency breastfeeding visits, actually get to meet former clients for tea (right, Brooke?), or even walk to "meet and greet" visits on South Granville or in Kits.

Think of the reduced environmental footprint! (Still toying with the idea of getting a scooter...)

All of this ties in with my philosophy of being conscious and conscientious about all things, and putting family first. By moving into town, we're saving gas and time consumption, and bringing our family closer together (one sister even lives upstairs)!

All of this will coincide with the birth of "my 700th baby." Client #699 gave birth just the other day (she lives so close to the hospital that she walked there after her water broke), with a whirlwind "the head's right there!" finish.

Here's hoping that Client 700 won't give birth on moving day. But, since babies tend to have a wry sense of humour, I'll kind of expect it...

See you in Vancouver on the 27th!

Thursday, June 07, 2007

Statistics for the Utterly Confused

I usually wait for a full year to pass before doing my client stats, but a lot of doctors, nurses, doulas, childbirth educators, and clients have recently been expressing concern about the high epidural rate (reports are as high as 80%) at local hospitals. A recent article in The Vancouver Sun also reported that the cesarean rate in B.C. had climbed to almost a third of all births, far in excess of what the World Health Organization deems acceptable.

So, here's a glimpse into my own client outcomes from January 1/07 to June 7/07. Now, remember, these are not a special group (i.e. highly motivated multips under age 30 with a history of fast births). These are 30 women with an average age of 36, most (73%) having their first baby, who hired me to help them and their partners. The majority entered the process without hard and fast expectations about the birth experience. They all hoped to "do their best on the day", some wanting an epidural at the door (and not needing it), and some wanting to avoid a cesarean (and needing it). They are all capable and amazing women.

30 clients
Ages 27-42 (average age is 36, with only one woman under age 30)
22 (73%) primips (including 1 twin SVB)
8 (27%) multips (all SVB, including 3 successful VBACs, no epidurals for any multip)
4 (13%) cesarean births (2 after many hours (one 5 hrs.) of pushing, both posterior babies - 9lb6oz and 10lb, 1 placental abruption, and 1 with malpresentation and incoordinate contractions from large fibroids)
9 (30%) overall epidural rate - all primips, this includes 4 later resulting in cesareans, plus 1 prophylactically for SVB twins, and 4 for pain management with subsequent SVB)
13/22 (60%) of primips had no epidural

Other facts:
18 (60%) arrived at hospital at, or close to, full dilation (Please note: This is not an aim, but a side-effect of the fast labours that often occur with a doula. Clients are encouraged to attend hospital when they feel it is "time," or if they feel anxious, unsafe, or worried about the baby.)
7 (23%) are medical personnel (including 3 family practice doctors, all primips)
1 (3%) client (primip) had her baby at home before I could reach her!
19 (63%) had family doctors (of these, 89% were SVB, with a 21% epidural rate for FP group)
8 (26%) had obstetricians (all primips with OBs had epidurals, only one cesarean in OB group)
3 (1%) had midwives (1 cesarean, 1 vacuum, 1 SVB)

No editorial comments here...analyze at will... - Jacquie Munro, Vancouver Doula

Note: SVB means "spontaneous vaginal birth"

Friday, June 01, 2007

Lessons from a Happy Flying Baby (Advanced Level)

Did I tell you that I think that labour lasts as long as you need to learn all the lessons required for this particular child? There’s perhaps a little extra time added to work through some particularly tricky past life experiences. The baby’s personality has a lot to do with this...

One of the family doctors I know, said that all three of her boys had labours to fit their personalities. One came flying so fast that his cord broke. And that’s how he goes through life - flying headlong into things (both physically and emotionally). Another son takes his time, considers all his options, then considers them some more. As a result, his labour took a long, long time.

My daughter is strong, powerful, never wanting to follow the crowd. When I was in labour, her head was trying to forge a new, totally different path - out my hip. Later, her high school math teacher said that she would pound away at a problem for a long time, only to later discover that if she just turned the equation around, the answer was there - and simple. That sounded just like her labour, since she eventually tilted her head, and came easily.

It’s interesting, but my clients who have the quickest births often have the hardest time adjusting to parenthood. They often tell me that they just can’t figure out their baby. In a 15-minute labour, there’s not much time to learn the lessons that you need to parent this child.

So, be thankful if you have a long, gradual labour. There are many benefits to the lessons learned during this time - lessons that you will draw upon for a lifetime. You might even begin to understand that labour and birth is something that’s out of your hands, and that's okay. When things are slow, it's not "your fault." It might just be your baby speaking to you through your body...

So, listen. - Jacquie Munro, Vancouver Doula