Monday, July 09, 2007

An Argument for Non-Linear Thinking

I just love how our brains work. Well, I actually only know how my brain, a woman's brain, works. And it's totally non-linear. My daughter's brain works like mine, and people laugh when they hear us talking, shifting from one subject to another without any apparent link. Ah, but we independently followed the link from five minutes earlier in our conversation.

Birth is also feminine, non-linear. It works like a woman's brain. There are multiple tasks being accomplished at any one time - descent, rotation, softening, opening. Almost ESP-like communication can take place between a woman and a wise caregiver - this is the "monkey-brain" or "reptile-brain" at work. Thoughts, memories, past experiences, and current understanding are accommodated, merged, drawn upon.

"It's in the core," she says. "Yes, I can hear the baby descending," I say. "No more than twenty minutes. Hear me." "Yes, I feel it. It's right there," she says. "Safe," I say. "Okay."

There is so much going on beneath the surface in birth. Getting the right flow in labour is like searching for the point on a radio dial where there's no static, where the signal is pure. Intervention, too much noise, or touch can increase the static. A woman needs empty space in her brain in order to birth in her own way.

This makes my brain jump (in a non-linear manner) to a blog post that I read by Carl Honore yesterday. He had just been at an IdeaCity conference in Toronto and wrote: "One of the comments that has struck me most came from a physicist. (Note: Most probably he was thinking about physicist, Lawrence Krauss, and his discussion of dark energy.) He explained that 75% of the energy in the universe comes from empty space. This is wonderfully counter-intuitive. I may be stretching things here but it also seems like a nifty metaphor for the power that is unleashed by slowing down. When we become still, it looks like nothing is happening but in fact, beneath the surface, all kinds of extraordinary thinking and exploring is going on."

A woman's body in labour is like the universe. She gains most of her power in labour from the empty space, or dark energy. She is only able to access her full potential when she slows down to her basic self, when she is uninterrupted, untouched. We hardly know anything about dark energy. But Lawrence Krauss says that "It could be that dark energy reflects the anthropic nature of our universe, which implies there are other universes. If we could get evidence for their existence, this would be a remarkable breakthrough."

We've always been told that we only use a small part of our brains. We now also know that we only understand a small part of how our universe works. Only 4 percent of the universe is made of the kind of matter we have always assumed it to be - that part which is solid, us, our planet, the stars. 96 percent of the universe is, as yet, unknown.

So, it follows that we can only know a small part of how birth works. When we think we know it all, we really have no idea. I think only women in labour have a glimpse of the potential of birth. In labour, we know we are experiencing something almost unknowable. We know that we want to be undisturbed, deep inside ourselves. We can almost touch the doorway between life and death when we are in labour.

In labour, we accept the existence of other universes. It is huge, it can be scary, but it is us at our most elemental. There is so much dark energy in labour - as much as is present in the universe.

Dark, not as in negative or bad, but unknown, unwritten.

If, in labour, we are able to slow down our brain, be still within ourselves, and avoid the interruption of static, we might be able to firmly touch this untapped dark energy in labour. The power is both unknowable and knowable. Totally amazing. Pure physics.

Totally non-linear. - Jacquie Munro, Vancouver Doula

L'Arbre et Le Fruit

Here's a little excerpt from an article by Dr. Michel Odent, noted French obstetrician.

"According to traditional wisdom in rural France, a baby in the womb should be compared to fruit on the tree. Not all the fruit on the same tree is ripe at the same time. A fruit that has been picked before it is ripe will never be fit to eat and will quickly go bad. It is the same with a baby. In other words, we must accept that some babies need a much longer time than others before they are ready to be born. If you have some apple trees in your garden, you will listen to your common sense and choose an individualized and selective approach: you will not pick all the apples on the same day."

A recent client was concerned that she would be induced, as she had been in her first pregnancy. I had the confidence to tell her that her physician would not induce labour, even if she reached 42 weeks, as long as she and the baby were well. I could say that with confidence because I have been working closely with this particular group of family doctors for almost 20 years. This gave her peace, and she was able to relax. Soon after, she went into labour on her own, well after the typical "10 day limit" imposed in most North American hospitals. All was well. She could hardly believe the wonderful difference from her previous, induced, labour.

I live in a bubble, working as I do with midwives and family doctors who respect the current research, dare to challenge hospital protocols, and fully respect their clients' rights. I am fortunate to work in collaboration with caregivers who dare to wait, who only induce women if it is truly medically indicated (even if it causes a fuss with other staff!) In reality, this means I rarely see a woman face induction.

I am glad that I only work with caregivers who follow the best care practices. We work in concert with each woman and her body. Labours start on their own, women dance and move freely, women are continuously supported, women do not face regular interventions, women give birth standing, kneeling, or wherever they choose, and the women reach to pull the babies to their breasts. (Left brain dominant? Click here.)

In birth, we are not the keepers of the power, each woman's body is. Yes, we have to do our homework and ensure that everything we do is supported by the best evidence. But, after a while, the 21st century knowledge is only a backdrop to the ancient truth of birth.

So, if a woman's body is the tree, then the apple will fall, as it should, whenever it is ready, and will rest on soft safe ground. And the orchard keepers will be sitting, as they should, with their hands beneath them, in the shade of the tree. - Jacquie Munro, Vancouver Doula

Saturday, July 07, 2007


Wow! I don't generally talk about "non-birth" things on this blog...but we walked to Fifth Avenue Cinema last night to see "Once"

The link to birth is that it made me smile, hand over face, just the way I do when I'm witnessing a women deep in labour...


Friday, July 06, 2007

7 in the month before 7/7/07...things are going swimmingly...

In the month before 7/7/07, I attended 7 births.

To honour these families, here are the condensed stories...

1. In labour, trying to make sure the men renovating her house wouldn't notice ("we waited so long for them to come and do the fireplace"), she dashes over to the contractor's house...only to be told by me to run down the stairs, get into a car, and meet me at the hospital. I could almost hear the dilation in her voice, and feel the baby's descent... So, we did perhaps the first "doula on headset" birth, dad and I driving to converge at the hospital, my voice quietly speaking into her ear through each contraction...and calling the hospital and doctor on my other cell phone. Dad remained calm...mum remained calm...and the baby was born in short order upon arrival at BC Women's. Phew!

2. Contractions were still "do-able" at 3am...we wait for the moment when the contractions make her "move"... Back circles, hip shakes at 4:30 should make the difference...ah, yes...dancing, moving...all the right signs by 5am...born at 5:30...9lb 5oz..."No wonder that hurt!" Baby suckling on mum's neck at 6am. A lovely night.

3. She walked to and from the hospital...with a husband on crutches. Need I say more? They're all amazing!

4. If her phone had packed it in a few minutes sooner, she would have given birth alone in an upstairs room. Luckily, there was just enough time for her to call her partner and I, get to the hospital, dash up to the best room in the house, have a shower, then have a baby - sunnyside up, no less! Thanks to Wendy for being such an amazing nurse, coming in just for us, and helping to facilitate yet another untouched birth.

5. When a woman is sick with a cold or flu, the body seems to take pity on her, and make the labour that much faster. Well, it worked again. Another quick birth. Softly breathing through each contraction, accepting each wave as it came, she birthed a beautiful baby boy before too long...then he peed all over dad's pants! "Hey pumpkin, what do you think?"

6. Dark hot night, fan blowing... She labours in the tub, moving with the contractions. The power builds, the midwife arrives...she now believes it can happen...legs "wide open like wings"...and the baby slides out into dad's hands. Milk and chocolate afters. "Just lovely," says mum.

7. This little one waited until he was good and ready. And no induction this time! Mum and son were at the beach...I walked to her house, and she gave birth with the sand still between her toes 2 1/2 hours later. Thanks to the nurses who believed me when I said the baby was coming FAST! Thanks to Dad for getting little one to sleep for his afternoon nap, so he could make it to the birth! the next one should be at home.

It was an honour to be a part of these births. Welcome to the 5 boys and 2 girls!

On "Beyond Evidence: The Complexity of Maternity Care"

I must say that I've had a long-standing passion for Murray Enkin. I was first "introduced" to him in 1987, when he was an obstetrics professor at McMaster University, and was writing "A Guide to Effective Care in Pregnancy and Childbirth". His book became my "bible". The underlying thesis of the book is that evidence from well-controlled trials should encourage the adoption of useful measures and the abandonment of those that are useless or harmful. The full text of the 2000 Edition is available online, courtesy of the authors!

Dr. Enkin's insightful comments in the "Guide" made me respect his judgment. His pragmatic review of the research helped to guide me in my role as a doula. I would photocopy pages of the book to give to clients, to help them negotiate the best care during pregnancy. Over the years, I have always checked in on his current research, and tried to follow his teachings.

I only recently learned that Murray Enkin mentored my family physician when she was at medical school at McMaster University. She said that his nurturing taught her how to respect the value of research, while honouring the complexity of life, the effect of random variation, and the nuance required when providing health care at the highest level.

So, it didn't surprise me when I stumbled onto a Guest Editorial by Murray Enkin, published in December 2006 in "Birth" called "Beyond Evidence: The Complexity of Maternity Care". Once again, here was Murray Enkin encouraging us to move forward from our dogmatic approach to research. Thank you, Murray!!!

There has been a movement afoot to solely rely on "evidence-based care" in obstetrics. This phrase quickly became a buzzword in midwifery schools and doula circles. Dr. Enkin argues that there is a fundamental mistake in using this approach in obstetrics. The complexity of obstetrics demands a different approach, one that considers the complex interrelationships among the separate elements at play.

"It is not simply the woman or the setting, the attendant or the policies, that influence the outcome" in labour. He argues that this renewed understanding can "point us to the steps we can take to move forward. First and foremost, we need to accept the uncomfortable reality that there are no comprehensive formulas. A cookbook for maternity is not in the cards."

"We must learn to think of the relationships among the disparate factors that influence each birth, each setting, each situation, rather than of the factors in isolation. We must allow new forms of research to evolve, to produce new kinds of evidence, and to accept the value of this new evidence."

As a doula, I need to keep current. I need to know that I'm providing my clients with all the information they need to make the best choices during their pregnancies and births. To do that, I read the MCDG list daily, consult MIDIRS, Birth, The Cochrane Library, and the world's major research institutes (I'm especially fond of Canada's own Journal of the Association for Research on Mothering). I branch out and draw on essays and writings from different areas – literature, history, anthropology, comparative religion – to discover more holistic answers to birth's questions. I also GoogleScholar any topic my clients ask about, to ensure that I'm up to date. I call on my most trusted midwives, family physicians, spirit medicine providers, and others, as I continually search for new ways of approaching birth. Oh, and I can now call on my daughter, currently a writer/researcher with the Rural Maternity Care Research NET, when I need a sounding board.

I also trust that my attendance at close to 70 births per year counts for something in terms of continuous experiential research. I must negotiate the myriad differences and inter-relationships evident at each birth – with different babies, women, partners, caregivers, hospital staff, and family members.

I must practice "evidence-based care"…but I like to think I go beyond that, to consider a higher, more complex level of care, as Murray Enkin suggested.

Thanks, Murray, for keeping my passion alive, and for teaching me that wisdom is worth nurturing as much as research.

- Jacquie Munro, Vancouver Doula