Monday, December 22, 2008

Birth with Two Snowmen


Birth is never what we expect. Even though we may say we don't have expectations...we do.

So, when I arrive at the hospital around 6am with a client who is 7cm and stretchy to full dilation...there's a part of me that expects her to be happy and nursing her baby by lunchtime. Admit it, Jacquie...after almost 800 births as a doula...you do have certain expectations.

Yes, I must admit, I do have some expectations. But, so do you. If someone told you the birth story later..."she had her beautiful baby girl at dinner time"...you might say, "I expect that she had an epidural (isn't that something that usually slows the labour?)" But, no, she had no epidural, no pain meds at all. Things just slowed down to 1 or 2 contractions every ten minutes for most of the day. She even managed to sleep.

What made things slow down? Probably not just one thing. Perhaps it was a combination of our collective expectation (totally subconscious), head position (asynclitic/deflexed), and/or compound presentation (hand or cord in the way?) Or maybe it was, as some cultures believe, the will of the baby. She might have just wanted to be born at dinner time..."I don't like breakfast!"

So, though I'm sure we all had the expectation of a quick and uncomplicated birth, that just wasn't this mum and dad and baby's story. This birth was our reminder to respect the need for infinite patience, and to respect each baby's journey, each family's journey together.

How else would we all have had such a special day to watch the snow quietly, honour the passage of time, and see their family gather, build two snowmen, and shed great tears of joy when the baby finally arrived. I don't think the day would have been quite so wonderful otherwise.

- Jacquie Munro, Vancouver Doula

Thursday, December 11, 2008

The Recovery Effect

It's really odd. Whenever I'm recovering from an illness, all the births come easily and quickly. So, what's with that? In the first couple of weeks after I returned to work after my Uterine Fibroid Embolization, I laughingly said to clients that I could only manage a 6-hour labour. It was a joke! But, they all obliged.

No, I don't really think it's a fluke, because it's happened before. When I was recovering from pneumonia one year, all births in the recovery month were speedy, and I seemed to spend less than 6 hours with each. No kidding! (And, no, it wasn't that I showed up late and left early.)

It seems to be the same effect that occurs on a day when there's a nursing shortage(due to fabulous weather?) at the hospital. If I'm told by the assessment nurse that there are only beds for women who arrive "ready to push", then my client miraculously speeds to full dilation in no time at all.

The mind is a powerful and wonderful thing...

My only worry is...now that I'm totally well and feeling great...will my clients have long births again?

Hmmm...a dilemma...

Anyway, here's a snapshot of the births that I've attended recently...

Eli - Ah, the beautiful boy who wanted to get here extra early. "What? They want to send you to Prince George to have the baby? I'll fix this!" And we fixed it. Phew! Now THAT was a whirwind birth...17 minutes from "I think the baby's coming", was it?

Eva - How can I be even more emphatic in future when I tell clients to get in the car (during what they think is early labour) and head to the hospital? "Yes, I know your first birth was long...but you had forceps! There's a wide open freeway available for this baby, and she's going to use it!" We met at 69th and Oak...and panted and breathed all the way to the hospital. I'm so happy that we have cell phones to alert the doctors and nurses that we're INCOMING! "We did it!" cries mum.

Noah - Another second baby who followed the "slow slow easy...BOOM!" entry to the world, thanks to a doctor who knows how to spin babies. I love these posterior babies with strong personalities. They certainly know how to make a grand entrance when they decide to come (4-10cm in 20 minutes)!

Ella - A first baby who wanted to pretend that she was a second baby... Ella made her mum dance and sway, then make a dash to the backseat of my car (funny memory of the concierge trying to focus on reading his paper while she laboured in the lobby). Zip up to Cedar at BC Women's...and voila! Ella came so quickly that it surprised pretty much everyone. The sun shone through the skylight...amazing.

Lauren - Wow...another first baby who wanted to earn the speed record (4-10cm in less than 2 hours, when you'd expect 6 hours). I just love mum's words as she started to push..."It wasn't that bad." ...and dad noticing that the baby sounded like a "baby pterodactyl". Just wonderful!

Oscar - He came so quickly for a first baby...unexpectedly born in the hospital, but home before bedtime. His mum laboured with grace, and his dad touched his head, a sacred act, just minutes before he was born. Sweet pea!

Amaan - A dark night...driving through the rainy streets...a long walk up a hill to the hospital entrance (stop, hug, pant, breathe)...then gentle care as the baby comes quickly. "I did it! I felt it all!" Welcome little one.
What a triumph!

What a joy and a gift to be able to be a witness these miracles.

- Jacquie Munro, Vancouver Doula

Monday, October 20, 2008

Good as New

Touch wood...I'm feeling as good as new and ready to work!

I'm not allowed to lift anything (like a post-cesarean mum) for a while yet...but I generally don't plan on lifting pregnant mums. That's a job for the dad!

So, please don't hesitate to call me!

Saturday, October 11, 2008

"Oh, is this the fibroid?"

Well, well...take a look at the quote above. Picture the scene. Lovely, caring and chatty admitting clerk walks me up to the ward (with my dear husband). Since it's 6:30am, there are no nurses to be found. A nurse comes out of a room and wanders down the hall (was she sleeping in there, I wonder?)

The clerk says, "I have a new patient for you," and the nurse replies, without looking at me..."Oh, is this the fibroid?"

The clerk pointedly answers, "Her name is Jacqueline Munro, and she's here to have an embolization this morning."

Rather than making me upset, this dehumanizing language almost almost made me snort with laughter. Three thoughts instantly came to mind: 1. Sarah Palin (queen of the stupid comment). 2. If only I was a cartoonist, then I could have done this comment justice. 3. Who teaches these young nurses anyway? Empowering and respectful language is paramount, girls!

Thankfully, shift change comes quickly, and my pregnant (of course!) day nurse K was lovely!

Thoughts and questions about my hospital experience...

1. Everyone should have a doula...for anything done in hospital. At least the doula would make everyone introduce themselves!
2. Catheters without an epidural are not fun...not exactly painful...but very unpleasant.
3. Why are patients blamed for the nurse's inability to successfully insert an IV on the first try? "You mustn't have been drinking enough water." (Nope...I'm floating in the stuff!)
4. Nice art work in the recovery area at UBC...very nice... (Okay...I must be drugged) The Fellow says I have more fibroids than she could count (I love being unique).
5. Why did the anesthetist play Bob Dylan's Blowing in the Wind? And why do the nurses and resident think that it's Willie Nelson (They're TOO TOO young to be working on my body!)
6. Why did everyone start talking about Halloween while I was being given a cocktail of conscious sedation drugs?
7. I want to thank the porter for singing me lullabies while in the elevator.
8. I'm not accustomed to having a heartrate of 44 (Is this the effect of fentanyl or morphine? Yikes!) The talk of atropine doesn't thrill me.
9. The bed was quite comfy.
10. Wherever I go...even when I'm totally drugged...people tell me their birth stories in great detail, and want to know if I approve of their doctor/midwife/OB/hospital choice. I just want to sleep!
11. Who added those sickening bumps to 16th Avenue?
12. Why don't I remember seeing the specialist whose name is on all my prescriptions? Was he hiding or did the fentanyl make me forget?

One client said she's happy that I'm going through all this...at least I'll have the hospital experience fresh in my mind. Well, I can tell you that I can now relate to having narcotics (I stopped taking them asap), that I understand the agony of post-surgical gas pains and nausea (someone needs to warn you about this BEFORE the cesarean), that I know the feeling of a digestive system that isn't quite ready to start working again (also - thoroughly unpleasant), and that I now feel like I'm 10 weeks pregnant (and waiting for the morning sickness to go away).

But, I can also say I'm in awe of the fact that my hemorrhaging stopped as soon as I was in recovery. I'm happy about that...but still waiting for the other shoe to drop.

Each day, a little bit better. Those healthy wishes from friends, family, clients and blog readers really do help. Thanks!

p.s. The photo is of a fibroid knitted by a medical student...

- Jacquie Munro, Vancouver Doula

Tuesday, October 07, 2008

I'm off to see the wizard...

I'm off to see the uterine fibroid wizard at UBC Hospital first thing in the morning. "No food after midnight, etc., etc." This is all new territory for me. My only previous major hospital stays have been for my children's births. Though I'm going in for a different reason, the focus is still on the same body part...the uterus. Everything I do seems to revolve around this amazing muscle. I hope it cooperates tomorrow. I should be up and running in a few weeks...

Wish me luck!

Thursday, October 02, 2008

Lady in Waiting

If you’re having a hospital birth, perhaps one of the most challenging parts of labour is the transition from your home to the hospital. Many couples worry about the car ride to the hospital, but it’s amazing to see how most women manage the ride with surprising grace. If the car ride is timed so that it coincides with the trance induced by high levels of endorphins (well past the mid-point of labour), then the whole journey can be manageable.

To illustrate - I vividly remember one client’s ride to BC Women’s from UBC. It was around 4am. She threw a coat over her naked body, somehow managed to run to her car down a long apartment hallway (between contractions), then crawl onto the back seat of her minivan, exposing her bottom to an old man in a trilby hat, who was coincidently walking his little Scotty dog past us at that moment (you should have seen his face!) Bouncing along in the car, this normally private woman laughed and laughed. “That was FUN!” Yes, the trip was uncomfortable, with her husband trying to negotiate hundreds of potholes, but the absurd nature of the trip far outweighed the pain it may have caused.

The stories that result from the car ride can be epic, from the woman riding to the hospital with her head popping out of the sunroof of a Mini, to a recent dad’s call to BCAA: “I locked the keys in my car with the engine running at the Emergency entrance to the hospital!” If you’re lucky, you’ll notice the absurdity in the moment, and laugh.

Now, it’s the hospital assessment room that can be a possible source of stress. If you’re lucky enough to have a midwife who has already completed the assessment at home prior to hospital arrival (which happened last week with one client), you might manage to bypass the assessment room altogether - yahoo! - and go straight to your birthing room. This causes a lot of excitement and very little stress.

The next possibility is that the family doctor will meet you at the front door and do the assessment personally. The continuity of care provided in this scenario is wonderful, and the time spent in the assessment room can be relatively short, provided the hospital can quickly assign you a nurse. There’s also the added bonus of having an additional advocate present to help negotiate the hospital protocols. If I’m lucky, I can coordinate this...but it’s really hit and miss.

If the family doctor is busy with another birth, or en-route, or your primary caregiver is an obstetrician or resident, then we have to hope that the assessment room is not too busy, that all the other women in the assessment room don’t require high levels of care, that the staffing levels aren’t low on this day, and that there’s more than one nurse available to care for the 5 beds in this area. Fingers crossed that the assessment room stay won’t drag into multiple hours, which can easily happen. (I always try to call first, so at least I can alert my clients to the possible delay.)

There are a lot of variables that can increase a woman’s stay in the assessment room. The assessment room nurses (who are amazing, highly qualified, and caring people) do everything in their power to take into account BOTH the triage process and each labouring woman’s needs. There’s a lot of paperwork to be done, protocols to follow, personalities to placate... The assessment room nurse needs 8 arms, two heads, and more than a little wit and understanding, to make it through each shift.

It may appear to clients (husbands especially, since the labouring woman is generally just focused on each contraction) that the nurses are sitting at the desk doing nothing. Often, the people sitting at the nurses desk are not the assessment room nurses, but interns, residents, other doctors, or even a clerk. The supervising nurse in assessment must juggle all her patients to ensure that the woman with the highest care needs can proceed to the next “level”. Granted, the nurse might not be able to explain what she is doing for each woman during the process, but that’s what I try to cover with clients in between contractions. “Yes, it might look like you’re being ignored, but you’re NOT. She’s left the room to negotiate with labour and delivery to have a nurse transfered up to Cedar to be with you, so you don’t have to wait until a Cedar nurse returns from her 45-minute break, etc. etc.” It’s my job to fill in the gaps in information. But, if I need to breathe through the contractions with the woman in labour, the dad will have to wait a bit for my briefing.

Even a 45-minute stay in an assessment bed may seem like an eternity, but it’s about as fast as the system and safety will allow (unless you’re ready to push...then you get to fast forward!) For example, the nurse needs to read a woman’s chart thoroughly to determine her risk status, her drug allergies, her particular needs, and contact her caregiver (and wait for a response). If a nurse is forced to cut corners, a woman could inadvertently be given a contraindicated medication (i.e. fentanyl being given to a woman with an drug allergies), or miss important medical information. I am able to highlight certain important points when I speak personally with the nurse, but she must confirm this by reading through the notes, and then doing a thorough history and assessment herself.

The setting certainly doesn’t make a labouring woman feel safe or calm. The beds are narrow, the space is noisy... But, I ask all clients to imagine that we’re still home, to keep their eyes closed, to focus on a calming hand, the soft pillow, their partner’s voice, my voice. Often I have to talk the woman through each and every contraction, so that she remains calm between each contraction. Yes, she might roar during contractions, but that’s her way of coping. It’s the in-between times that tell us how she’s doing. If she’s able to breathe calmly between contractions, or even say, “Wow! That was intense!” or “I didn’t like THAT one!” then she’s fine. (I try to wangle assessment bed 5...the one with a DOOR!)

As a doula, the assessment room experience is certainly challenging. It takes years of experience to negotiate the process gracefully and diplomatically. Most problems can be prevented creatively. Petty staffing wars can be averted by anticipating them in advance, and steering clear of potentially tense situations (trust me, I’ve seen it happen recently.) Protecting the woman in labour is paramount.

Sounds like it’s better just to stay home until you’re ready to push (which is what one doctor laughingly suggested recently).

Hmmm...at least you have a doula with you who knows the staff and your caregiver, and can provide the best possible “concierge service” around...

- Jacquie Munro, Vancouver Doula

Ticking the "Home" box

A former client recently emailed me, asking me to write a post about home birth. Was she searching for information for the ongoing debate with her husband? Even though it is the woman who must ultimately make the decision about her birth setting, it is imperative that her partner is included in the process of informed choice, and comes to understand and support her decision, without fear.

Since I'm known as the research-oriented and pragmatic doula, I'd better throw in some evidence. So, here are a few things I want you to consider:

1. When you are presented with two equally effective treatments, then "best practice" requires that you take into account the patients' preferences (that means HER).

2. The Province of British Columbia Ministry of Health fully funds care by registered midwives, both at home or hospital.

3. A 1986 World Health Organisation report concluded that “home is the most appropriate birth setting for most childbearing women. Women (and their attendants) choosing this option must be provided with necessary diagnostic, consultative, emergency and other services as required, regardless of place of birth.” See College of Midwives of British Columbia.

4. In 2002, the "Outcomes of planned home births versus planned hospital births after regulation of midwifery in British Columbia" was published in the Canadian Medical Association Journal. The results showed that "women who gave birth at home attended by a midwife had fewer procedures during labour compared with women who gave birth in hospital attended by a physician." "Comparison of home births with hospital births attended by a midwife showed very similar and equally significant differences." The final interpretation of the study was that "there was no increased maternal or neonatal risk associated with planned home birth under the care of a regulated midwife."

5. In September 2007, the UK National Institute for Health and Clinical Excellence issued clinical guidelines (The NICE Intrapartum Care Guidelines) on intrapartum care of healthy women and their babies during childbirth. Under ‘‘key priorities’’ it stated: ‘‘Women should be offered the choice of planning birth at home.’’ Information suggests that for ‘‘women who plan to give birth at home or in a midwife-led unit there is a higher likelihood of a normal birth, with less intervention’’.

After attending almost 800 births in my 21 years as a doula, I can now say that I'm most comfortable (and I feel most safe, actually) at a home birth, with a client who has come to this decision freely, who is autonomous, who is radiantly healthy, whose midwives (there are always two present) are trusted and respected by all of us, and who has a partner who fully supports her decision without fear. But that's me...now.

I can't squish a woman into that mold. I would never want or expect everyone to be "that woman". A woman must go on her own unique and challenging journey to trust birth that much. I trust each woman to make the decision regarding the best place FOR HER to give birth, and with whom to give birth. I support each woman without reservation, no matter what her choice. In order to give birth at home, a woman has to gradually grow into the person who can make that decision. I know I didn't reached the point where I would have chosen home birth until I was 31, after giving birth to two children, and after attending over 100 births (many at home). Until then, I simply didn't have enough information to make an informed choice about home birth myself, even though I HAD made the amazing, and life-changing, leap to midwifery care for my second birth!

So, to the couples who are spending evenings debating home birth (she wants it...he's not sure...grandma says "over my dead body"), please do your homework. The research is clear. The more difficult task is to deal with the images swirling in your heads - images born of myth, misinformation, and fear, fueled by society's expectations and the media's lopsided representation of birth. You need to talk to people (call me - my clients would love to share!) about their personal experiences of home birth, watch movies which include home births (like The Business of Being Born or Le Premier Cri), and understand that choosing home birth doesn't lock you into that option. It just means that you can now include another option in your choice of birth places - you can now tick the "home" box.

When asked where she was planning to have her baby, one family doctor with four children would always say, "Wherever it wants to come out!" (In the end, she had #1, #3 and #4 at home, and #2 at the hospital) Because...on the big day, if you've given the body and the baby both options (hospital AND home), their final choice is always loud and clear!

Now, if I could only let you into my head to see the images of the home births that I've attended...but that's for the next post...

- Jacquie Munro, Vancouver Doula

Monday, September 29, 2008

Lying in...

Well, this month has continued to be full of lessons for me. I've been listening to my body and caring for it very well. I'm astonished at how much better I feel already. Though still anemic, I'm light years ahead of where I was in August. I can climb stairs and not pass out! My heart isn't racing if I walk to the bathroom! I realize now that I was living in a perpetual state of "pseudo-9-month-pregnant life"...you know, that period where you deliberate over moving the bed into the living room just so that you won't have to climb the stairs...or find that linking arms and sauntering is de rigeur (rather than your usual non-pregnant power walking).

I'm well enough to feel good about heading into hospital on October 8th. I'm not daunted by the post-procedure pain that I've been warned about ("You should be able to relate...it's like a couple of days of labour," said one doctor.) I'm not going to fight the suggested recovery time of a few weeks... I will listen to my body and honour its needs.

(p.s. The amazing painting is "Crawl Out" by Vancouver artist Madeleine Wood)

- Jacquie Munro, Vancouver Doula

Thursday, September 11, 2008

Listening to your body

Well, it's certainly been an interesting month...I now know how the VGH ER works when you really need it (yes, the triage system works well and I jumped to the front of the line!), how little an IV hurts when you REALLY need it, and how fast you can get appointment with specialists in the BC Medical system when you are considered URGENT. I also know the odd, prickly, clammy, scary feeling that comes from losing too much blood...very interesting (from a professional standpoint), but I don't need to experience it again.

The whole time, my mind stayed in doula mode..."Ah, that's what a good fast IV feels like"..."Interesting - even though you know there's no needle in there, you just don't feel like waving that IV arm around". I was happy to receive such respectful care from the VGH staff (who even turned around my bed to face the wall so I could gain more privacy during an exam, without me asking). And, in the middle of caring for me, one nurse chattering, "Wow! You attend births? I think cesareans should be the way of the future...I'd rather crack open a chest than watch a birth. You're so brave!" I laughed, even though I felt ready to pass out.

And I can still see the smiling face of the ER doctor as he came in and said, "I want you to know that the biopsy was negative for cancer." I almost laughed...I really (amazingly) hadn't considered that to be even a possibility. It was quite funny, honestly.

Interestingly...I presented with such CRAZY high blood pressure (I've NEVER even seen a client with HELLP syndrome have this high BP) that I got 3 nurses at once. Hmmm...probably not something to brag about. So...I'm not pleased with my body this month, and that's an odd thing for me.

I always tell clients that they can trust their body, that we just have to figure out what the body is trying to say. Well, I'm listening and waiting...

Perhaps everyone's right in saying, "Look, you have cared for others for 20 plus years. Now it's time for us to look after you."

So, thanks so much to my docs, Stephanie and Kristin, for telling me to take this month off, and expediting matters so successfully. Thanks to my clients who call to check in, or send text messages that make me laugh. Thanks to my husband (for taking time off work to care for me) and my family (my mum and dad even come and clean for me!)

And that postpartum tip about asking for help? It works! If you just tell people how you really are doing...they will step in and help. It's quite amazing. The struggle for new mums (and now me) is in the acceptance. I think I'm good at acceptance now.

So, to all my current clients due in the next few months...we'll just have to see how my appointment goes next week, and then I'll be giving you a call (surgery may await!) My daughter, Sarah, and I might be doing tag-team birthing for a while. But, I'm always here, ready to listen and help guide you through your pregnancy (this hasn't affected my mouth or ears!)

Okay, body...I'm listening...

Thursday, August 07, 2008

The curse of the efficient woman


I always encourage clients to send me a blog post after their birth. Here's a post that I asked dear Kate to write after she told me about one day in her "life as a new mum". I'll be writing more about her amazing home birth (and the string of amazing home births I've attended) recently....as soon as I've had some sleep...

"This is for all the women who are doing very well... you know the kind - maybe you are one. One whose families are wondering, why does she keep calling her doula every two days? Surely a doula is just necessary for the labour part. Maybe even your husband, who was over the moon at having a doula present at birth, is a little skeptical:

"You like calling Jacquie, don't you?"
"I do! And she says we can call as much as we like anyway!"
"I guess she hopes that it tapers off after awhile, even though she says she's ours forever."
"Well she doesn't expect it to taper off THIS quickly!"

My father's partner calls this "the curse of the efficient woman".

I admit it, I'm doing well. My labour was short (so short, we didn't make it to the hospital - hurray for homebirths!), my stitches have healed, my breasts don't hurt, and we get some sleep every night. My baby is gaining weight and generally seems happy. Now he is five weeks old, and I made it out to stroller fit yesterday. Today,with Sacha happily sleeping in his baby wrap, I cleaned the garlic we've grown in our garden and made a fresh batch of granola, all before noon - perhaps I am an efficient woman. But even we have 24 hour periods like the one I'm going to tell you about, when Sacha was just 3 weeks old...

Nana, my mother-in-law, was visiting, and we decided to head out to Langley to pick up some berries. While we were there, I figured I ought to have lunch with my baby sister, still just 19, who lives there with her mother (who is not my mother). Anyhow, my sister has a stepsister, also 19, who had a baby 4 days after mine. I have worked hard to avoid jealousy over the fact that my own baby sister has another nephew to adore just when I have provided one for her... So when, during lunch, my sister holds Sacha the entire time, but talks steadily the ENTIRE time about the OTHER baby, I do my best to smile and encourage. After all, a teenage mum needs support, and I should be glad my sister is helping out so much. When we were sitting in the restaurant after my sister leaves, Nana takes Sacha and says to him, "Well, Baby X sure is a perfect baby, isn't he?". I laugh, relieved that I'm not crazy. And after all, I am doing well... so I still have a sense of humour.

Later the same day, Sacha, Nana and I are on our way home... Unfortunately, we overshoot feeding time by about 15 minutes. The last bit of the drive home is a combination of wild, distraught screaming from Sacha, punctuated by eerie minutes of silence in which I become terrified that he has screamed himself out of air... But, we make it home and he gets fed. I laugh, relieved that I can so easily meet my baby's needs. I am doing well...

Midnight that night, disaster strikes. I have fed Sacha, and burped him. When I lay him down right after a feed, he gets the hiccups, starts to cry, and things go downhill from there. So I am in bed, slighltly propped up, with him on my chest. Have I mentioned my son is strong? Somehow, while I am semi-dozing, he pushes up, rolls to the side...and right off me onto the floor. I jump up with a shriek, pluck my beautiful baby off the hardwood floor, and lay him on the bed to examine... he hasn't even woken up... his eyes open as and he sees me above him, talking hysterically to his father about whether he is concussed, whether we need to take him in to the hospital. Meanwhile, Nana runs into our room having heard the fuss... there I am half naked sobbing "I d-d-d-d-ropped him on the fl-fl-fl-floor..." We all notice that my nursing pillow is on the floor right where he landed.. Everyone concludes that he landed on the pillow. And, well, babies get dropped (I got dropped 3 times on my head according to family lore). I laugh, relieved that Sacha is ok, there are no bumps and bruises. Nana goes back to bed. But I am officially NOT doing well...

"Aren't you mad at me?" I ask my husband, still sobbing.
"Of course not. You didn't mean to, and he's perfectly fine!! "
"But if you'd done it, I'd be FURIOUS!!"

I cry some more over my own double standards... Eventually, my husband suggests that I take the baby downstairs for a cuddle so I can work out all my guilt. I follow his advice, and an hour later I manage to put the baby in the bassinet and throw myself back into bed for a few hours of desperately needed sleep.

The next morning, I am feeling fragile. But having been reassured by my husband, mother, and mother in law that I am still a trustworthy mother, I venture out. With the baby, the dog, and Nana, we walk to the grocery store. We get groceries (stored nicely in the stroller, while baby snuggles in a sling). I have overshot feeding time again, and since I'm not about to subject any of us to a long bout of crying at this point, we stop at an off-leash park. The dog runs after sticks while I feed Sacha. Suddenly, my friendly, bouncy lab-cross who still looks like a puppy at nearly 3 years old, starts barking and running towards somebody across the playing field behind us. I jump up, babe in arms, shirt half off, receiving blankets flying, and see that Nellie is headed toward a mother and daughter across the field. Now, I know my dog is all bark and no bite. But, THEY don't. They see a large, black dog tearing towards them. Unfortunately, the mother seems to have no sense of how to react to a dog, and starts screaming. Not just a yelp - repeated, high pitched, terrified shrieking. The daughter follows suit, and just to add to the effect, they both start running in circles. Nellie thinks this could be a fabulous game, and keeps on charging towards them. They keep shrieking and running in circles. I start to wonder how this is going to end as I'm yelling "SHE'S FRIENDLY, JUST STOP SCREAMING. PLEASE!!!!!!!!! STOP SCREAMING!!!!!!!!!!!". I alternate this with yelling at Nellie to come back. After a few crazy seconds that felt like minutes, Nellie comes prancing back, very proud of her efforts, and the mother and daughter aren't shrieking, but the mother is yelling at me from across the field, accusing me of having a vicious dog off leash (in an off leash park, of course). By this point, I am shaking, the baby is crying, and Nana is trying to pull the pieces together. We put Sacha in the stroller with the groceries, get Nellie on her leash, and make a beeline out of the park (as fast as we can considering Nana has recently finished a course of chemo, and I still have stitches on the mend.) I laugh, glad that Nellie didn't reveal any new aggressive tendencies, but there is more than a little hysteria in my voice. I'm not convinced that I'm doing so well...

We make it home. I go to use the washroom and see that I have acquired a blotchy rash all over my neck and face. Nice touch. Nana suggests that it might be stress related, takes the baby, and sends me for a nap. An hour of solitary sleep and a tearful phone call with my own mother later, and I feel like I could possibly soon be doing well again.

So, for all of you who generally do well, and maybe don't feel like the roller coaster ride of early motherhood is quite as crazy-making for you - don't fall prey to the curse of the efficient woman -- let everyone know that you need just as much TLC, and make those phone calls to your doula!" - Kate, mum of Sacha James (and Nellie the dog)

Friday, July 25, 2008

"Silence is the perfectest herald of joy" - William Shakespeare

I remember going to one of my first doula visits (with the woman who would eventually give up her law practice and become a doula) and talking with the couple about all the things we had to discuss before labour. My client's husband later confided to her that he was alarmed by how much I talked during the visit. "Oh!" I said. "He hasn't seen me at a birth. I'm so quiet. My eyes and hands speak, but not my voice." He was so relieved (I think I'd actually scared him at that visit)...and I went on to attend all three of their children's joyful births.

The reason I talk so much at our prenatal visits, is that there is so much to cover. My own children are in their twenties, and I have been discussing birth with them all their lives. I STILL haven't covered it all with them! Can you imagine trying to filter all the information to fit into two visits (and many phone calls) with clients? It really can't be done.

The best I can do is help my clients get a sense of the underlying philosophy of birth, to encourage them to trust their bodies, to help them to remain undisturbed while going through labour. I still talk and talk before labour begins. But, the volume goes down to a whisper once labour is upon us, just as the lights go down....because we have to be silent to hear the lessons that the coming baby has to share.

- Jacquie Munro, Vancouver Doula

Tuesday, July 22, 2008

Coming up for air...

Okay, so I've officially decided that the full moon really MUST make babies come in groups!

In the past week there have been so many babies, with their due dates randomly spaced over a six week period. Thankfully, there were no overlaps. Well, there was one 8-minute gap between two clients (it took me 8 minutes to run down the hill from one completed birth at St Paul's hospital to the next client's house on Pacific!)

So, there were two undisturbed home births, two undisturbed hospital births, and two challenging births caused by sweet posterior babies (resulting in one cesarean and one vaginal birth). The largest baby (9lb 13oz) and the smallest baby (6lb 12oz) this week were both born vaginally with no meds. What a ride!

Here are some wonderful quotes from the women in labour:
"I'm not scared, it just hurts."

"Once a contraction's over, you feel like you're in paradise."

"That was good! Almost no pain!" (about contractions in the shower)

"You have no idea how hungry I am right now!" (said at 10cm)

"That was the best experience of my life!"

"When his head came out, there was all this liquid, and it almost healed me..."

"I never knew he'd be this beautiful."

"I never knew she'd be this beautiful."

Now, if everyone else could just keep their legs together for a couple of days... I have my daughter's engagement party to get sorted!

- Jacquie Munro, Vancouver Doula

Monday, July 07, 2008

Baby at the Breast


















Sorry...shamelessly proud mum here. My daughter Sarah painted this Warhol-esque breastfeeding baby (acrylic on canvas) as part of her final Breastfeeding Counselor project. Love it!

Now that we're on the topic of breastfeeding... A lot of women mistakenly believe that they will automatically receive incredible breastfeeding support at the hospital and during the initial weeks at home with the baby. Sadly, this is just a myth. Read about the resignations of local lactation consultant extraordinaire Renee Hefti, and then sign up for the breastfeeding courses that she offers in the community (604-733-6359).

Shameless promotion here - but it's truly necessary!

- Jacquie Munro, Vancouver Doula

Monday, June 16, 2008

Doula as "Obstetric Technique"

Check out the MedWire News synopsis of a new study that was recently published in the journal Birth (2008: 35: 92-7)

Doula support reduces cesarean and epidural rates
by Lucy Piper 03 June 2008
Examining the perinatal effects of doula support for nulliparous middle-income women accompanied by a male partner during labor and delivery.

MedWire News: The continued presence of a doula during labor significantly reduces cesarean delivery rates and the need for epidural analgesia in middle- and upper-class U.S. women accompanied by their male partner or another family member, researchers report.

They suggest that maybe fathers should not be expected to fulfill the role of primary labor companion.

Susan McGrath and John Kennell from Case Western Reserve University, Cleveland, Ohio, USA, investigated the potential benefit during labor of an experienced doula to provide both emotional and instrumental support. A total of 420 women were randomly assigned to either have a doula present throughout labor in addition to their male partner or no such additional support.

Women who had the support of a doula had a significantly lower cesarean delivery rate than the control group, at 13.4 percent versus 25.0 percent. They were also less likely to need epidural analgesia, at 64.7 percent versus 76.0 percent, respectively.

Among women with induced labor, just 12.5 percent of women with a doula had a cesarean delivery, compared with 58.8 percent of those without a doula.

All women and their male partners who received the support of a doula rated their experience as positive.

"Continuous labor support by a doula is a risk-free obstetric technique that could benefit all laboring women and should be made available in all maternity units," the researchers conclude.

Fabulous study (Under "Do your Homework" in the sidebar, click on Birth: Issues in Perinatal Care or read the entire study via Recent Notable Journal Articles.) Who knew that continuous support by a doula would ever be called a "risk-free obstetric technique?" Only in the U.S., eh? The guys at Monty Python could have really used that in their birth scene in "The Meaning of Life"..."Oh, and we're forgetting the doula, that new risk-free obstetric technique! Put her next to the machine that goes "Ping!""

But, don't let that one phrase muddy the results of the study...they're great!
- Jacquie Munro, Vancouver Doula

Sunday, June 15, 2008

Ten Questions

I think there’s a purpose behind the nine long months of pregnancy. This time is vital for introspection, reflection, setting boundaries, and discovery. As I’ve said so many times before, birth is not a “body” act...it’s an act of the soul and the mind and the will.

Yes, I have a checklist of the things that I need to discuss with clients...and worksheets for them to fill out if they’re “paper people”. But, in order to serve my clients well, I need to go further, deeper. So, over the months, we talk on the phone discussing everything from diapers to spirituality. I often ask couples some unusual questions to help them uncover how their life experiences may affect them during the birth and postpartum. Usually, the deeper we go, the greater the understanding, resulting in a much more positive emotional experience for everyone.

If we skim the surface in our phone calls or visits...or if clients don’t share honestly with me...or give me only SOME of the pieces to the puzzle...then the house of cards may fall down, and a challenging birth and postpartum period may result. I can only work with the information that is given to me.

So, thank you to all my clients who take the time to build a bridge of earned trust. Thank you to those who hear me, to those who share openly and honestly with me, their partners, their families, and friends. Those who share without masks or guilt or shame should find that the process of pregnancy and birth will take them to a whole new level of living.

So, here are just 10 of the questions that I may ask over those nine months...some might appear unusual...but there’s a method to the madness...
  1. What kind of an suitcase packer are you? Do you have games to see who can take the least amount of stuff in your MEC duffle? Or do you always end up paying for overweight luggage? (This question is not just about what you pack!)
  2. How long does it take for you to make decisions - on your own, and as a couple? Did you take 10 years to decide to get married? Or do you often kick yourself for being too impulsive (like Dharma and Greg on TV)?
  3. How much guilt do you take on in life? Do you think you’ll be able to be pragmatic and avoid “mother guilt”? (We have enough guilt in the world...)
  4. Would you ever consider going on standby? Would you be okay with the wait? If three flights were cancelled, would you just “roll with it” or feel like you were being tortured by the wait? (One dad described waiting for labour as “Sitting at the gate, waiting for a standby flight to Auckland. You know New Zealand is beautiful, and you’ll love the trip, but you have a love/hate relationship with the flight - you might even get to the point where you want to jump out of the plane - but it’s all worth it!”)
  5. As a couple, how do you think you would you do on “The Amazing Race”? Would you be the “bickering couple” or the “couple who accepts any challenge happily”? Would you spur each other on to better things, or do you think you’d give up? (One couple described themselves as the “bickering couple” who you know love each other incredibly - and win!)
  6. When you’re on a big ride, or hike, or in competition, how to you respond before the endorphins kick in? What strategies have you come up with to cope with your known response? (I whine initially, but my husband encourages me, lets me go slow, then cheers when my endorphins kick in - the best supporter!)
  7. What kind of family boundaries do you have? What family issues are swirling around you as a couple? Would you be able to say “We’re on a baby honeymoon...and we’ll see you in two weeks”? Or would your families’ actions become the talk of your small town? (One couple went “underground” for a week at week 2 postpartum, because they had been bombarded by family visits, and the new mother/baby connection had suffered as a result. Going “underground” helped them to claim their autonomy as a new family.)
  8. What was your role in your family of origin? What was your partner’s role? How do you plan to reconcile the differences as you become parents yourselves? (One client realized that her actions as a first-born, and her husband’s actions as the “baby of the family” required discussion prior to the birth of their first baby...and looooong walks on the beach.)
  9. What has been your greatest emotional challenge in life? How did you cope? How has it changed you? (One client said being thrown into the shark-infested waters of the Indian Ocean made her face her fears. Another said writing her bar exam taught her to take life “lightly”. Another said her battle with cancer at age 19 had changed her “from a lamb into a warrior”.)
  10. What have I missed? Is there an elephant in the room? (Though I’m not the family physician or midwife, I do need to know, in advance of labour, if a client has a clinically diagnosed fear of giving birth. That happened in 1990...and it’s a long story... )
- Jacquie Munro, Vancouver Doula

Tuesday, May 27, 2008

Vancouver or Bust!

One of my recent clients is a doula from Fort McMurray. She drove all the way to Vancouver to have her baby. I was honoured that she asked me to support her and her partner (and sister) through her labour. With her permission, I'd like to share a part of her email that she sent me after she had driven all the way home with the new baby (only a few days after the birth!)

"I really wanted to email you and say thank you once again for a terrific job and your incredible support. I drove to Vancouver with hopes for an amazing birth, and I couldn't have imagined it being any better, even though it was longer than I anticipated! I wrote down my birth story as you suggested, and literally just finished reading your notes. Like you said, it's so funny what a different perception you have when in labor. I love the quotes you wrote down, and I honestly thought you had arrived at my sister's place at 4am, not 4:45! You make the birth sound like it happened a heck of a lot faster than what I remember it feeling to be. What an incredible experience! Thank you for making it be so.

I can't remember if I explained this to you or not but bear with me if I already have. There are three things that you did which were crucial to my needing encouragement to carry forward. The first was the 2:30am phone call I made to you where I said I was considering going to the hospital to walk or have my waters broken and you said, "No, you're not. Go to sleep and let your baby and your body do what they need to do." I had read a birth story before driving out to BC, and this women spoke of a laboring tradition in Africa where a laboring Mom is guided to a log by village women who have not yet had children. This woman crosses the log by herself with no help and is welcomed on the other side by all the women who have children. At my sister's apartment I ventured out onto the log and at 2:30am I got stuck there. Your voice at 2:30am showed me the way across that log on my own again and you greeted me on the other side. It was amazing.

Secondly, was your word of "Safe". In my own time, mostly during a warm shower at home, I would envision myself in labor and I found myself singing a mantra of "It's okay, I'm safe here." I never explained this to you beforehand and you using that word during my contractions at the hospital renders me speechless at how effective it was in guiding me. My husband asked later if this was a word that you and I had chosen together and I said, "Not at all. She just knew."

Lastly, when it came time to get onto the bed and my contractions were extremely intense, you held onto my thighs firmly, almost as counterpressure, and it was incredible how more in control I felt during my contractions when you did this. It is definitely a tool I will carry forward when I begin doula work again. I know the hip squeeze is a welcomed favorite among my clients, but just that security of the firm hold you placed on my upper thighs was incredible. Truly.

So, thank you again so much for all that you have both helped with and taught me about. My gratitude for the opportunity to work with you
goes beyond words, and should I choose to have a fourth baby in Vancouver, I sure hope I can work with you again."

...And I thank HER for letting me be a witness to her power on that day!

- Jacquie Munro, Vancouver Doula

Wednesday, May 21, 2008

Le Premier Cri

Don't you love Paris? There, in the Opera Metro station is an ad for an amazing birth movie. Would you ever see that here? A birth movie in full theatrical release?

However you can view Le Premier Cri, find it, view it (I googled and found the complete movie in a free download...search hard!) Yes, it's in French, but please forget all the French that you know, and listen to the birth sounds, the music, not the words of the narrators.

The cinematography is breathtaking, the births are achingly beautiful. I found myself laughing out loud in joy at the woman in Mexico being carried to her car in a blanket and transported to the seashore just after giving birth. I wanted to be the woman moving beautifully through the South American jungle to the river - stripes on her belly. There is truth in this movie.

Find this movie - the search will be worth it...

(Note: I've been getting emails from people who can't find the movie...ask a teen...honestly...they'll have it for you before the end of the day...as long as it's legal in your area.)

Peasant Feet










I usually get at least one or two phone calls a day from clients upset about the pregnancy comments and “war stories” that other women feel the need to share.

“I don’t want to hear it any more!” said a woman to me this morning.

Another client said she was literally trapped by a cousin at a family gathering...wedged in at the back of a table, locked in between a great-aunt and the story-telling cousin. “The baby’s head was SO BIG that they had to...(insert whatever horror story ending you like here).”

These comments, so freely given, can stick with you, and really hurt. Or they can turn what was a carefree pregnancy into a time of anxiety.

“Wow, you’re big!” or “Boy, you look small for your dates!” or “Make sure you get an epidural in the parking lot!” or “I’m just going to book a cesarean next time! You should, too!”

The endless combinations of horror stories and thoughtless comments are awe inspiring.

In our phone calls, I usually remind my client that it’s perfectly acceptable to say you’d rather not hear the stories...or just stick your fingers in your ears and go “LA LA LA LA!”
Protect yourself from these stories - using whatever means available!

Now, I’m not pregnant, but I was given a taste of how my clients feel just the other day. I was feeling pretty good. It was the long weekend, I’d been to a lovely birth overnight, I’d slept well, and knew that no babies would arrive on that day. As a treat I thought - I’ll look for some new sandals (I’m usually a no-nonsense “get in and get out” kind of shopper). I sat down with an array of pretty sandals to try on.

“What size?” asked the clerk. “Ten,” I answered.

She came back with a pile of boxes...then looked down at my feet. “Oh!” she exclaimed, “I should have had a look at your feet first! You have PEASANT FEET! Just like me! You won’t like those...you need something much, much wider.”

Then she proceeded to go to the back, returning with a clunky (ugly!) pair of servicable fish-net runners. Ugh! “Those are better for you.”

*sigh*

So, okay, people. Here’s a plea. Keep your comments to yourself. We’re happy to live in our own little worlds, with our own (perhaps misguided) ideas about our own bodies, our babies, our lives...whether we’re pregnant or not. We don’t need to hear your war stories, your “birth as rape” or “birth as prison” stories...or even how teenagers are going to ruin our lives. A positive outlook really doesn’t hurt anyone. I choose to think positively!

Personally, I like the fingers in the ears, “LA LA LA LA” approach. Now, I’m just going to shove my peasant feet into some nice flip flops...or, better yet, go barefoot to visit my next client.

- Jacquie Munro, Vancouver Doula

Tuesday, May 20, 2008

An Undisturbed Birth

I've been talking a lot about "an undisturbed birth" lately.

The language that we use in labour is so potent. I'm uncomfortable with many descriptive terms surrounding birth, such as "I'd like a normal birth"...or "She had a natural birth" ...or "We did a pure birth." It sounds like all others are abnormal or unnatural or impure. Birth just should be.

So, it came to me, recently, when I realized that so many of my clients have what I describe as "she just went into labour and then had the baby" births...they had all been undisturbed in labour. My role is to keep her private space protected and undisturbed, to help her feel free to move undisturbed, to be the guardian of her cave. She remains hidden, unobserved, in a safe space.

Even if I'm with her, I cast my eyes down in respect, until I am addressed. Often, I am just a hand, or a whisper, or even a silent presence beyond the curtain. Her partner sits still, a great gift, close by.

The photo shows it all. She is safe, alone in the shower. Her partner, and I, and her midwife, watch the rippling reflections on the floor, listen to the rhythmic pulsing of the shower, become transported, lost in time.

Our job is to help her remain undisturbed.

But...Oh, no! Here's the night nurse, who I usually adore. But she walks in at 7pm, saying loudly..."Och, it's HOT in here!" We all put our fingers to our lips...hope the woman dancing in the water doesn't hear... Later, the woman says her body tensed up at that moment, and she thought, "Oh, no, she's loud and Scottish!" and it took a while for her to get back into her undisturbed rhythm (and she later came to love the accent).

An undisturbed birth is a challenge to achieve, but its effects are immeasurable.

- Jacquie Munro, Vancouver Doula

Do you need a doula? (or...I am your Sherpa)

I was debriefing with a second-time client yesterday. She wanted to tell me how important it was that I was by her side at her second birth. “This time, lots of people said I didn’t need a doula - that you’re not a midwife...that the doctors and nurses would be there to help me. But I knew that you’d be there just for me - and I trust you. I knew you were there in my corner - always.”

Her husband thanked me for being there again - for helping to create such a positive experience. He put it all down to what he calls “the Jacquie magic”...the fact that everyone in the hospital treated them differently because they were with me.

It’s sad, but true. The hospital staff do treat patients differently depending on their caregivers. They’re human - they have their favourite doctors, nurses, and doulas. I really would love a world where everyone walking through hospital doors was treated equally. But, right now, it doesn’t happen...so if I can do anything to make my clients feel more autonomous, more respected...then I will. Petty “wars” can be waged between overworked and under-respected staff, and I do everything in my power to prevent my clients from being a witness to negative behaviour. Preventative magic helps.

It all starts prenatally. We cover every possible scenario in our talks over the phone, in person, via email. We discuss the woman’s hopes and fears, interspersed with stories of her life. We talk about how the couple works together, what their strengths and weaknesses are, how they face challenges separately and as a couple...even how they’d react if they were bumped from an important overseas flight. We discuss family dynamics, setting boundaries, postpartum planning. The prenatal preparation isn’t about following a prescribed path - its about finding how each woman’s life experience has uniquely prepared her for this particular birth. Whether she needs to do soprano vocal exercises in labour, or relive that amazing underwater night dive in Fiji, conquer the West Coast Trail’s ladders once again, or run the Paris marathon with each breath during labour - we will uncover her own history that will carry her through to birth. My job is to protect her from outside disturbance without her ever noticing (it’s kind of like trying to be the best server possible).

Luckily, since most clients are referred to me by their caregiver (and others), I know that there is a web of security and trust between us all. I may have known a woman’s midwife for 15 years (from the wonderful “community midwife” days)...or have been the family doctor’s own doula...or have known the doctor-on-call with the extremely dry wit (who my client has never even heard of) for 20 years. I know their style, their particular sense of humour, how they react when they’re tired, how they react when they’re sad, and most especially, how we can all work in concert to provide the very best care for my client. We often know each other well enough that very few words need to be spoken. This helps the woman to stay in her birth trance, without interference or complication.

At home in labour, after the client has spoken to the caregiver, I can offer additional information. The other night, in between contractions, I only had time to say...”Hi! Second baby, just vomited, some bloody show, some pressure, we’re coming in. Oh, and she’s GBS positive but doesn’t want antibiotics.” “Fine,” said the doctor, because he knew he could trust me that this baby was coming fast. I called the hospital and spoke with the assessment room nurse, who said - “Hi, Jacquie. We’re short four nurses because they called in “sick” on the long weekend, so no Cedar (the fancy rooms with windows) tonight. But we have a room for her.” When we reached the hospital, the nurse and I exchanged glances as soon as we walked through the door. “Hey Jac...pushy?” The couple didn’t really have to say anything - they could stay in “the zone”. We went straight into a birthing room - no stopping in the assessment room. She stayed standing by the bed. No “please lie down, put this gown on, etc. etc.” Her wishes were honoured without debate (the nurse and I had had the GBS-decision discussion a few weeks ago, so there was no need to belabour the fact on this night).

At the hospital, I know NEVER to show up at the end of a shift, when tempers are frayed - you will either be left to wait for the next shift, or be caught in the vortex of emotions borne out of 12 hard hours. If the vibe is weird in the assessment room (like it was a couple of weeks ago), I know the nurses well enough to whisper, “What’s up?”, and be trusted enough to be told the truth - that everyone’s on edge because an obstetrician wrote an incident report after a woman was sent to Cedar without allegedly fulfilling the criteria (long story). A war is brewing. We negotiate, and figure out a way (enlist the dad’s aid) to have my client go upstairs to Cedar without it causing a problem for the nurses in assessment (diplomacy in action). We’ve been through enough that we’ve built up a trusting relationship, and are able to work together collaboratively, seamlessly, so that my client doesn’t even suspect that we averted a petty war on the hospital floor.

I’ve worked with clients giving birth at home and in the hospital for over twenty years. I’ve quietly built bridges with midwives, physicians, and hospital staff. I’ve worked to earn the trust of each nurse and each unit clerk (these women have their finger on the pulse of the place). The amazing thing is, each new client reaps the rewards of the cumulative history of all these births, and all of the experience gained from those who have gone before her.

I’ve learned to chatter less and listen more, to teach by example, to foster trust in each woman and her baby, to soak up every lesson, to read voraciously, and to constantly tend the bridge of trust and diplomacy with all caregivers. Because I am autonomous, and not affiliated with any group or hospital (no affiliation = no baggage), I can focus on each individual client’s needs and wishes without prejudice.

I’d love there to be a day when I could trust that each and every woman in labour could be autonomous and free to give birth undisturbed, that her history would be one of complete trust in the body, that no doulas would be needed. But, that’s not possible in today’s society, within the current health care system. Each woman still has her labour, her own history, AND the system to negotiate.

Each woman in labour still needs a navigator (one midwife recently said that I have to add "Even with a midwife!"), or as I laughingly say at times, “Just think of me as your Sherpa,” as I carry the bags up the stairs. Each woman climbs her own mountain, while I quietly deal with the bureaucracy, the logistics, climbing up the stairs behind her, all the while chanting like Barack Obama...”yes you can, yes you can...”

- Jacquie Munro, Vancouver Doula

Saturday, May 10, 2008

63 new mums

Since last Mother’s Day, I’ve witnessed 63 women transformed into mothers. Pretty cool, eh?

So, to all the wee ones - give your mum a big wet kiss tomorrow!!!

(Sorry mums. It will probably be somewhere between 5am and 6am...but, babies never did have a great sense of timing...)

Friday, May 09, 2008

Okay...so here’s an excuse to buy new bedding

When a single friend calls to say that she’s had “quite the night!” it can mean many things. But, when a client calls me post-baby...well, it means something completely different.

So, a client called to tell me that they’d had “quite the night!” She said that they had kept the night-time as low-key as possible. “Just like you said, Jacquie...lights out...no eye contact with the baby (Ed. note: If she sees you looking at her, then it’s party time!)...making sleep sounds during feedings...not waking a sleeping baby, diaper changing before the feed if needed, etc. etc.”

“Things were going quite well. Then, at 4am, I felt like one breast must have leaked all over the baby during the feed. In the dark, I used my hand and a cloth to wipe it up, then curled up with her and fell asleep.”

“Just after 6am, we all woke up, the sunshine streaming through the thin curtains, illuminating the bedroom scene...of poopy chaos!!!”

“My husband said if the room had been filmed in black and white, it could have passed as a scene of carnage!” she laughed, as she was telling me the story over the phone. “There was baby poop EVERYWHERE! It was smeared all over my face, my nightie, his hair, the baby’s hair...just everywhere! In our sleep, we’d rubbed it all over the sheets. too. I’d taken off her diaper, but not put another one on!!”

“We could have cried. But, we just sat there in bed, laughing. Because we remembered that you’d told us a similar story of another couple doing this...and using it as a good excuse to buy fancy sheets. So, we threw everything into the garbage (Editors note: I know, I know... this isn’t an eco-friendly story) and got into a bath together - all three of us. It was quite wonderful.”

Love it!

Wednesday, May 07, 2008

Phone calls to a doula

To all pregnant clients...here’s a “head’s up”. Some time after the baby’s born...you will make this phone call. The wording and timing may vary, but the questions will be essentially the same.

“I’ve got this pile of books here. One says to get the baby on a schedule, another says to feed on demand. But what does “demand” mean? What if the baby comes off after 10 minutes. Is that a feed? When do I change the baby? Before, after, or in the middle of a feed? Am I wrong to want to grab my baby away from visitors? You know, they’ve come all this way, and brought presents, but I just want to hide...”

We’ll probably spend up to an hour on this particular phone call. We’ll laugh together...we might cry together...then you’ll hang up the phone floating on air. Why? Because you will have been reminded of your infinite strength, your inner wisdom, and your ability to trust your body and your baby.

My role during the postpartum period is to help you tap into the same basic instinct that took you so beautifully through labour. Let’s assume, like most of my clients, you birthed without any disturbance, and everything was straight-forward. So, there shouldn’t be any major challenges to overcome (i.e. no latch problems caused by narcotics or aggressive suctioning, etc.) So, I will just have to remind you of your power that you drew on in labour, and remind you to continue trusting your body.

And, with the baby on the outside, you will trust her to teach you wisely and gently. You will be still and calm and hold her close always, in order to hear what she needs to teach you.

Just know that you will find it pretty freaky when she give you a withering look at midnight, as you’re changing her. It’s a look that will seem to say, “Oh, no, you really don’t know what you’re doing.” But then the look will be gone, and she will roll with whatever you’re doing, or cry and tell you a few stories. But she won’t hold a grudge. She’ll be amazingly forgiving.

And you’ll soon discover that changing her before a feed will save a lot of clean up time...because if you jostle her and change her AFTER a feed, she might easily throw up all over you and her new jammies. Then, she’ll be wide awake...and need another feeding...and the doorbell will ring...(don’t answer!)

And you’ll soon discover that zips and buttons and snaps can make you feel TOTALLY incompetent, so you’ll just buy those bag nighties with the envelope neck. Pull up the nightie, change the diaper, pull the nightie down. All done!

And you’ll also discover that a newborn baby is kind of like a 15 year old boy. “Hey, mum, I’m just going out to grab a bite.” “But, you just ate an hour ago!” “Yeah, great dinner, mum. Thanks! But I need a pizza.” No, you didn’t do a bad job as a mum. He’s just growing like a weed! Same deal with a newborn. Cluster feeds, marathon feeds, feeding every hour....whatever happens, it’s normal. Trust the baby to know what she needs - she won’t overdo it. And miraculously, she’ll morph into a more predictable creature at some point after 6 weeks.

Thinking about dinner...I like to think of the breasts like...Side A is dinner...Side B is dessert. Sometimes you want dinner without dessert. Sometimes you want a break before you eat dessert. Sometimes you go straight from dinner to two helpings of chocolate mousse. Whatever happens, it’s normal. You know, just like those nights when you have dinner (great dinner, right?) then have dessert...then want popcorn at the movies...oh, and some nibs, and a big drink. Then the next day you might just want salad. Do you analyze it to death? Do you need to read a book to see if you’re normal? No, it is what it is.

And that’s what life is like with a new baby. If you just roll with it and trust your body and your baby to figure each other out, it will work out fine. If you need a few pep talk phone calls along the way...then you’ll be just like every other mum.

“So, oh...before you go...I have to remind you to...
...lock the door to visitors who just want to hold the baby (and not vacuum)...
...turn all the clocks around, especially at night...
...sing out loud...
...and be easy on yourself...”

- Jacquie Munro Vancouver Doula

i carry your heart with me

If I had a newborn now, I would search for poetry to read aloud during each feeding, to calm us both and feed our souls.
- Jacquie Munro







i carry your heart with me(i carry it in
my heart)i am never without it(anywhere
i go you go,my dear; and whatever is done

by only me is your doing,my darling)


i fear

no fate(for you are my fate,my sweet)i want

no world(for beautiful you are my world,my true)

and it's you are whatever a moon has always meant

and whatever a sun will always sing is you


here is the deepest secret nobody knows

(here is the root of the root and the bud of the bud

and the sky of the sky of a tree called life;which grows

higher than the soul can hope or mind can hide)
and this is the wonder that's keeping the stars apart


i carry your heart(i carry it in my heart)

- ee cummings

Monday, May 05, 2008

Snapshots of Love

A woman sings old remembered songs in a shower. The sound of her laughter echoes in the room and blends with the sound of the water.

“Hands!” A woman opens the shower door during a contraction, reaches out and holds onto her husband’s...and my...hands. When the contraction ends, the door closes and her eyes close.

Only a few hours away from birth, a woman takes time between contractions to place tin foil on the sofas and chairs; her power remains.

“I like it here” says a woman as her head burrows into the corner of the car’s backseat.

“Hips!” “Water back!” A woman moves autonomously in labour. She calls to us to take our places during each contraction...at the hips, at the back, and at her hand.

“Happy?” The lips turn into a smile, her eyes crinkle, the water runs over her body.

“Shhhhh” Her eyes gleam as she looks at her newborn, rooting for the breast.

All these snapshots are of women under the influence of the “love hormones” - oxytocin, endorphins and prolactin. As a doula, I continually witness the softness, the power, and the amazing transformational effects of these hormones, which are released when women are undisturbed.

So, with these snapshots of birth "as I witness it" in my head, I watched The Business of Being Born online last night. The enormity of the loss of normal birth, the rising infant mortality rate, and the rise in planned cesareans in the U.S. struck me like never before. Michel Odent’s warning about what we could potentially lose made me dream about births all night.

Are we, as a civilization, beginning to lose what makes us human?

I spent today speaking with clients, and googling more of what Dr. Odent has said on the subject. In the Scientification of Love, Dr. Michel Odent explores this question, looking at love “from a scientific angle, yet with great respect for the beautiful orchestration of normal physiology as it works to its best capacity when it is undisturbed. Love, we learn, is a strategy for human survival.”

As critical as our need is to protect the environment, I think our need to protect the integrity of normal birth may even be more fundamental.

Saturday, April 05, 2008

6 babies in 2 weeks...

Each of these 6 births has an essence that will remain with me always...

Azure's birth - Shower and more shower. Clary sage really works. Then a "hands off" birth. This wee baby slides out like toothpaste from a tube. Incredible. Mum reaches down to bring her daughter to her breast.

Nora's birth - Kisses on mum's forehead by her love. After a gentle labour, spent mostly in the water...this babe crawls to the breast just like in the WHO video, to the shock of the nurse, and smiles of the mother.

Sean's birth - Intuitive partner by her side, she makes each difficult decision with grace and patience. A challenging birth, but one where the baby's needs were honoured, and the body trusted to tell its own story.

Sasha's birth - A gentle spirit. A flashbulb memory from half way through...she's dancing in a dress from Bali...just beautiful...working to spiral her baby down...down... Her husband smiling, laughing.

Luke's birth - Women's hands anchoring her feet, she leans on the dresser, partner stroking her back...and ohhhh's her way through another contraction. Birth works.

Jessica's birth - Powerful, furious body power! Rocking back and forth, one foot in front of the other - she lives in a whirlwind of creative energy...with the cat reaching out a paw in a gesture of sympathy. The baby curls like a cat on her breast.

Monday, March 31, 2008

The Contraction Question

“I don’t think I’m in labour yet. I feel it really low down, all in front. It’s not hurting ALL OVER.” said the doctor on the phone.

“ALL OVER?” I asked, sounding like a parrot.

“Yeah.”

“Um...if all is well, it shouldn’t.” I was just a little bit confounded. Here I was, talking on the phone with a physician who’s been attending births for years. She’s amazing with her patients, so intuitive. Now, in labour for the first time, she was just as confused as everyone else in labour.

“Um...” I decided to go over the "what do contractions feel like?" question. “Primarily, it should stay down very low, near the pubic bone, like menstrual cramps, getting gradually longer and stronger over time. It can give you that drag-your-bum-down feeling. You may feel a sensation of heat wash over you, just like you’ve opened a pizza oven. You may feel shivery on and off. You might feel nauseous. You might have it radiate to your lower back. Everyone experiences a variation on the theme. But, you definitely shouldn't have that “grab your tummy and crumple up in agony because it hurts all over pain” as seen on TV. That’s just drama for TV. Real labour is something that you already know on so many levels. And it’s not linear. It doesn’t just get exponentially worse like on TV. It ebbs and flows.”

“Yes, I remember you telling me that. But I didn’t believe you or all the other women. So,” she asked, “when we palpate the contractions of a woman in labour by feeling the top of her uterus, she doesn’t feel any excruiciating pain up there?

“Not in a normal labour. It’s only when there’s something wrong and the body needs to get the message across BIG TIME that you can feel pain in weird places. If everything's fine, you should just feel the contractions way down low...”

“So...uh...what I’ve been feeling all day might just be labour?”

“Probably. The start of labour is something that you will only figure out retrospectively. But, I can hear in your voice that you’re having contractions about every four minutes. You keep fading out. How about if I come over, and we can figure it out together...”

Well, to make a long story short, I went over to find that she WAS in active labour. Her lovely son was born only a few hours later.

Now, I don’t tell this story to poke fun at the doctor, but to show that, no matter who we are, we all have various ideas about how contractions may feel. We've been bombarded by descriptions all our lives. But these descriptions tell us more about the person who is doing the describing than about contractions themselves. Our perceptions are unique. So, whether we’re a family doctor with years of training and experience, or have read every book there is on pregnancy, or have listened closely to all our friends describe their experiences...our personal experience of contractions will be unique.

No matter what, even if this is your first labour, the contractions will be something that you recognize. They may not be what you expected, but they will be something that you "know" on a gut level. Hey, you're not going to get to age 30-something and then have the body throw you a complete curve ball, are you? Trust your body to let you know what it needs. As a doula, my role is to help you navigate your particular labour, no matter who you are, and what kind of labour you are "given". I try to help you shut down your 21st century brain, and accept the logic of the reptile brain.

And, wonderfully, that’s exactly what this doctor had done in her own labour...

I think one of the reasons she had such a smooth labour was because she didn’t NAME it “labour” until her body forced her to acknowledge it. She didn’t watch the clock. She didn’t waste emotional energy on waiting for labour to speed up, or to perform in any particular way. She just let it go, basically ignoring it, just like you would try to ignore cramps during a particularly nasty period. Who cares that she'd done all this because she was expecting something FAR worse than the reality.

I’m actually in awe of her way of getting through labour.

Maybe we should all try it.

Change

Change. Is it always good?

In the next month or so, obstetricians at BC Women's will be changing their provision of care at the hospital. Rather than having three call-groups providing an in-hospital rotating OB consulting service (24 hour call, with each physician or midwife being able to choose one of the three available OBs, if a consultation is warranted, depending on the case at hand), there will be two obstetricians on hand (one primary and one secondary) at all times, each working 12-hour shifts, drawn from the combined pool of 20+ obstetricians that used to make up the three smaller OB groups at BC Women's Hospital.

When I heard about the change, I asked if caregivers would have a choice of obstetrician if they required a consult during labour. "No," said the head nurse, with a quizzical look. So, you'll just get who is available, not who might be the best "fit" (clinically and emotionally) for the client on that day. Even if an OB has been consulted during the pregnancy, if a family practitioner or midwife needs OB assistance in labour, they will be not be able to choose between the 2 OB's in hospital, but will only be able to consult the one who is designated for consultations. And remember, there will be one less OB in the hospital at any time. Hmmm...

I know that other hospitals have been using this one-OB-fits-all approach for years (e.g. St. Pauls - but they have a small pool of OBs, and a low-tech high-touch philosophy that seems to work well from the patient's perspective, and their nurses are given quite a lot of autonomy). At first glance, this change at BC Women's might appear to signal a departure from patient-centred care. But, apparently, improving patient safety was the primary motivating factor. So, it may be a good thing in the long run - the 12-hour shifts might result in more energetic OBs providing more focused patient care. But, the shorter work day (and the inability to chose the OB) could result a loss in continuity of care for the labouring woman. Could the positive working relationship between a family physician and a small OB call group be lost in this reorganization, causing further internal conflict? Who knows.

Will notice of this change be given to each woman prior to her decision regarding her primary caregiver for pregnancy, so she can make an informed decision about prenatal care? Now, this is a tricky question. Pre-conception information regarding "the caregiver decision" is already lacking in B.C., with many women making their decisions based on non-B.C. books or the internet. For example, many newly pregnant women don't know that B.C. midwives are covered by BC Medical (practicing in both home and hospital), or that the BC Women's "Birth Docs" are there for women whose family doctors don't provide obstetric care, or that, in B.C. (unlike the U.S.), obstetricians are not intended to be the primary caregivers of "low risk" women, but are consulted after a referral by a family doctor or midwife, if the pregnancy becomes "high risk".

As a doula, part of my role is to inform clients about their choices, their rights and responsibilities, and to help them to retain their autonomy. I'm also there to quietly remind them that birth is a normal life process. I do my best to provide my client with comprehensive information in a balanced and thoughtful manner, working in concert with their caregivers (many of whom I've known for 20 years). I certainly don't have all the answers to the questions that I've posed in this post, but a general wariness of change (I'm a Taurus, through and through) made me sit down to write this. Despite my feeling of unease, I'm going to have to sit on the fence with this one, and wait to see how it all works out.

To the obstetricians, it might look good on paper. But we'll just have to see how it works in reality....for the labouring women.

(Update June 11/08: The new system has been in effect for a while, and, while the obstetricians are well-rested and seem to have a new lease on life, I have witnessed some dangerous gaps in continuity of care when an OB is the primary caregiver of my client.)

(Update March 2009: Obstetricians are still voicing their concern about the 12-hour shift. Yes, they are well-rested and able to perform better in the OR, but some women have fallen through the cracks due to a lack of continuity of care. Some women may have three of four different OBs looking after them in labour, each with a different approach. No solution so far...)

Thursday, March 20, 2008

Persian New Year and "Fire Bum"

Last night was a perfect example of a final prep visit...with a bonus. When I walked into their living room I noticed some special items on top of a shelf, obviously placed with care. I could see potted hyacinths, coloured eggs, wheat sprouts, and more. The shining couple explained that it was Persian New Year, and that the altar held seven items that each symbolizes some aspect of rebirth and rejuvenation. I was honoured to be a guest in their home on this special day. It seemed fitting that we were talking about welcoming a new life into their home at the new year. Then, the cat jumped up and tried to eat the sprouts (to the cat it looked just like catnip, I guess...) So, ancient ritual and custom met the quirky reality of the animal world. That's kind of like how labour works...

On this second prenatal visit, always done in a client's home, I see the couple in their comfort zone. I also look for labour inspiration by seeing what's on their bookcase or what holds a place of honour in their home. After tea and a chat, we get active, and do a "birth rehearsal" through the rooms. Stick a glass to the wall and listen to my voice as we roam the house: "Oh! You can totally polish your hardwood floors with lavender wax in the last month - on hands and knees! That might help to keep things loose and, you never know, help to keep the baby in a good position. Oh, and that toilet is positioned perfectly so you can sit backwards on it in labour..." etc. etc... No, I'm not manic, just excited to show people how their body can move them through their own space in labour. It's quite fun for the couple, to see their home from this new perspective.

So, fast forward to later that evening. Here's the scene - I was demonstrating the "shaking the apples" move to them. "You don't just shake the hips, you rub fast, just like you're trying to make fire. You can feel the heat from the friction..." The dad took over and did it perfectly (I say perfectly, because she made little sounds of happiness.) "I'll call it Fire Bum," he says, smiling, and writes it down in a notebook. We all laugh! "Fire Bum!" A new name for this move is born.

We move through the apartment, with her trying out different positions (in this visit, we discover that she can lean on the kitchen counter AND slide her bum against the cool fridge at the same time - what a bonus in labour!)

I demonstrate the different power balance that happens when someone's standing above her, moving to her level, or kneeling at her feet. "Which feels better?" I ask. "Wow...what a difference...when you kneel at my feet it feels so good." She feels the power that will flow into her in labour as her partner holds her, their heads close together.

"But, watch the thumb wiggle," I laugh. I demonstrate and she shudders uncomfortably. "That's no good," she laughs. There is so much meaning in that thumb wiggle... So many times in labours around the world, there's a sweet man who places his hand on the labouring woman's leg (good so far), holds it there, pauses, then...starts to wiggle that thumb (yikes!!!) There's so much good intent in that wiggle - "I love you, I want you to be okay, it will be all right..." - but it just comes across to the woman (just on this one day) as fingernails on a blackboard. It sends the pain signals shimmering, expanding through her body. Yowzaa! A still firm hand, instead, acts like an anchor, sending powerful messages of safety and warmth through her body.

After two hours, all of their questions about the upcoming birth are covered, as well as trust, movement, honouring the body, non-verbal communication, back circles, mesmerizing back strokes (complete with waterfall images), rhythm and ritual (plus logistics - "Yes, you can really call me at any time, day or night!") They are ready.

So, I leave them at the door, a loving couple at the beginning of the New Year, so close to the birth of "a family".