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.”


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.