Sunday, March 29, 2009

Moleskine (or remedies for Slow Pregnancy)

It's interesting what the body does to us in the last weeks of pregnancy. Even the most active woman feels the slow pull in her mind and body, urging her to wind things down. Slow Pregnancy has struck!

Sure, you still feel motivated to go for long walks (more slowly) and swim (more leisurely paced) or even join a group on a Thursday evening (and do yoga), but your mind and body are slowly, slowly pulling inward, demanding attention.

In the past week, women have called to ask if they're losing their minds, asking what just happened to their memories, their attention span, their drive?

"Remind me what week you're at?" And the answer is always somewhere in the 30's.

The body does a wonderful job of making you focus on the internal work of pregnancy, whether you like it or not, in the third trimester. At 20 weeks, the thought of working right through to the end of pregnancy seems like a great idea. The pragmatic approach will save precious sick days or maternity leave time. But as week 32 approaches, the mind starts to turn its attention away from work projects, away from deadlines, away from stress and pressure, and there's a sneaking suspicion that, just perhaps, work isn't quite so important any more...

That's when I get the phone call. "My boss is on my back about the deadline, but I just can't be bothered. I can't even remember what I'm supposed to do next! There's this pile on my desk. And I'm the project manager! I'm looking at my calendar, and nothing makes sense. What's wrong with me? I just keep bursting into tears!" Nothing wrong here, it's just the last trimester, and big work is happening inside. It's time to listen to the body, and start slowing down.

It's quite amazing how the body manages to quietly work its magic. If there's too much stress in a woman's life, and the voluntary slow-down doesn't happen, eventually there will be a physical manifestation that will force her to slow down, leave work, or change to part-time or working at home. It could be a rise in blood pressure, or some body part "out of whack" requiring daily physiotherapy. The body has its ways of demanding attention. It always manages to get each of us to slow down. Slow down.

One engineer, working in an otherwise all-male office, developed high blood pressure and memory loss that scared her in her last trimester. This normally "together" woman burst into tears at her midwife's office, unable to even call her boss to say that she was going to have to stop working. Her midwife offered to call her boss for her. The woman was so thankful, but felt so guilty and overwhelmed that she wasn't able to even make a phone call. "Stress, combined with low hemoglobin and high blood pressure? at 34 weeks?'ll do it every time. Don't take on any guilt, you hear?" (In those days, Outlander was my prescription for her to read. Today, the equivalent would probably be Twilight. Trashy, easy to read, and great at lowering blood pressure if combined with your feet up on a good comfy sofa.)

And what about the memory loss? Studies have shown that, yes, you do lose some brain cells when you're pregnant. But, here's the amazing thing - mothering increases the neural pathways in our brains, making us unbelievably capable of doing a million things at a time. You just need to give it time. Let it happen slowly. Brains don't change overnight.

So, please be gentle on yourself, pack away the guilt, let the memory slide, slow down to Fiji time, allow the body and mind to complete the inner work of pregnancy. Be just a little bit less conscientious at work, a little less driven in the gym, a little more giving to yourself. Ask for support from those you love, from your friends, from your caregivers, or find professionals who can help you, physically or emotionally (your local hospital or health unit are ready and willing to help in whatever way possible, for free.) Read more junky novels, watch the clouds pass by, sit on a log and watch the waves...

Soon enough, you'll be able to multitask and work out, but AFTER the baby is born. There's plenty of time to be sucked into the rat-race of 21st century life, so please resist the urge to speed up for as long as possible once you have your gorgeous baby. Yes, please be slow and easy on yourselves. We are beautiful imperfect creatures who deserve hours of self-deprecating laughter each day.

P.S. I think I forgot to say something about those lost brain cells! I probably won't be able to remember a long list of things any more. But, that's okay. There's an easy way to overcome your memory loss. Just slip a little Moleskine lined journal into your purse so you can write down all your "notes to self", or ask for an iPhone with iCal as a group shower gift (I need BOTH because my brain is positively happy mush) and you'll be right back on track for the rest of your life. Right?

- Jacquie Munro, Vancouver Doula, Slow Birth, Slow Planet

Friday, March 27, 2009

There's always room for more babies!

Please email me to see if I have any openings for April, May, June or July. It never hurts to ask! Some babies have come quite early (amazingly!), so I have some emerging space available. Right, lots of room on that comfy sofa!

We'll be off to slow travel through Europe, while eating slow food, from the beginning of August until the first week of September. While I'm away, my backup doula will be available to field any questions or concerns...and even attend any early births!

I'm fully available for new clients with due dates after September 8th. Please remember that I ALWAYS have room if it's your second (third or fourth!) baby, or if you're a returning client.

- Jacquie Munro, Vancouver Doula, Slow Birth, Slow Planet

Wednesday, March 25, 2009

Dare to be different

Okay...this is starting to become a real pattern...

After each birth, the lovely nurse sighs and says to my client, "I haven't seen a birth like that in ages. Thank you!" Well, actually, yesterday's quote (by a British nurse) was, "I haven't seen a birth like that since I came here!"

Then, I ran into a nurse who had helped us at a birth last week, and she still was in shock that my client gave birth standing. "I tried to get her back onto the bed, I ASKED her to get on the bed, but she just didn't! I had to think, how am I going to do this, where's my stuff? I hadn't done anything like that before!"

"Oh, come on," I said. "You're creative! Wasn't it good to think outside the box at work for once?"

"No!" She was laughing while she said that, but she really had been outside her comfort zone at the birth. Why didn't she embrace something new and dare to be different? (Understand that she is otherwise a fabulous nurse, and really never let on that it was outside her comfort zone to my client...great diplomacy!)

I checked my client stats since October 2008 (26 births). There have been only three cesareans (11% - one breech, one face presentation, one true fetal distress). The rest have been water births, standing births, hypnobirths, squatting births, hands and knees, side-lying, etc. Some just had one vaginal assessment, some none at all. A few (18%, which includes the cesarean births) had epidurals (that had been their plan all along). The rest (82%) used water, movement, singing, TENS, dancing, and, for some, just a little bit of nitrous oxide gas, to help them through labour. Their ages ranged from 30 to 50 (yes, 50!)

Isn't the hospital epidural average well over 80%? (Must check recent stats...) Anyway, it's not 18%!

How do we do it? Well, I do have clients who are able to eat well, go for long walks, stay fit. But they're not really much physically different from most women. And...they all have their own anxiety, fears, and baggage. Some have battled emotional demons, and some have overcome physical and sexual abuse.

What I offer is the long, slow approach. I try to work with my clients over many months (slowly building trust), talking to my clients about the most recent research on mothering, birthing, parenting. I find out about their lives, what drives them, what challenges them. I ask them to call me whenever they are worried or scared, or whenever they just want to have a good chat. A phone call that starts with us talking about diapers, might end in her telling me that she was abused as a child, or has battled depression, or that she hasn't yet told her midwives that she's seeing a psychiatrist and is on medication. I help my clients to feel and know that they are safe. We trust each other.

One recent client went from "I really want an epidural" at our initial interview, to using hypno-birthing...and laughing and chatting as she entered the hospital at 8cm.

Another client went from having post-traumatic stress symptoms and battling depression and anxiety, to a home birth with joy.

And yesterday? Well, this woman had a lovely slow birth. She was another who dared to be different. After about 14 hours of deny-it cramping, she asked me to come just after 2am. We spent the next 9 hours with her on the ball, in the bath, in the shower, back on the ball, doing walkabouts, climbing the stairs, lunging, swaying, swirling. That's 9 hours. No, we didn't bolt to the hospital. She was confident in her and her baby's safety. She had a loving partner who stuck by her through it all (and who I could reassure throughout). I talked her through most contractions (except in the bath). " are safe...your shoulders are loose...your muscles are melting...your bottom is is wiggling down...your hands are soft...your face is soft...your legs are heavy and warm...soft..."

We waited until we had counted off at least 5 hours of good regular contractions under 5 minutes. We waited until she'd had significant bloody show (not mucous plug!) We waited until she'd had over 2 hours of self-described "8/10 power" contractions (up until then, her 3-minute apart contractions had been at 5-7/10). We waited until she was moving, almost dancing on her tip-toes during each contraction. We waited until she was deep in a trance of endorphins. We waited until she was just beginning to feel a hint of pressure in her bum from the bulging bag of waters (we didn't wait until it broke, but we could have waited, if she wanted.) We waited until she said she was ready to go to the hospital.

Then...she said the word, and we were ready to go. But then, we had to wait until all the shrieking children in the school-yard across the street had gone back into their classrooms after recess! the hospital. 7cm. That number scores us the good rooms upstairs. Into the bath, then walkabout, the birthing ball...and back into the routine that we had at home. "Soft, you are safe, your baby is safe." And infinite patience. And a partner by her side. Throw in a lovely British nurse who moves silently and gently. Add a young family doctor who intuitively respects a patient's need for autonomy. And then we stay by the woman in labour, and trust her, and trust her baby, and trust her body...and wait. One hour. Slow. One hour. Slow. One hour. Gentle. Slow. And, right on cue, she starts to feel the baby coming. An hour and seven minutes later, out emerges a beautiful pouty face...then oh! a little hand...then a smooth vernix-covered body. Hands reach down and baby Maggie is on her mum's chest!

And then it comes, the nurse shining and smiling, finally happy..."Thank you. I haven't see a birth like that since I came here!"

That was a first baby who dared to deny the hospital statistics. She had laughed at the almost 30% cesarean rate, the 90% epidural rate. She was undisturbed, unmedicated, and was given a slow and gentle birth.

We owe it to our children to dare to be different. This changes lives, and it IS worth the effort.

- Jacquie Munro, Vancouver Doula, Slow Birth, Slow Planet

Wednesday, March 18, 2009

Slow Escape

One thing that I love about working in the 'birth business' is that I don't have a structured schedule. Mine is more like a feast or famine schedule - no babies for two weeks, then BAM! four babies in three days. It certainly makes for an entertaining life.

Babies come whenever they like, and they always seem to come in a clump. Yes, a clump. "Group" would be the wrong word. A group feels orderly, predictable. But a clump - well, that sounds like just the right word for how babies arrive in the world. They seem to get a signal that NOW! is the time, and they all come in a clump, all jumbled together, jostling for position.

I attended five births the other week - five glorious, slow births. These babies didn't watch the clock (neither did their mums and dads and caregivers), and certainly didn't concern themselves about my lack of sleep. These babies came in their own time - one gently in the water, one with her mum's feet firmly planted on the ground, and a few with grand flourishes. But, they all came at their own pace - slowly, deliberately, safely. These babies taught us patience, and more than a few hard lessons.

So, when this recent clump had all arrived, I jumped at a chance to go with my husband on an impromptu visit to a small island close to our home. I didn't have any babies due for a week or two, so I could breathe easy, and run away.

We walked onto the ferry as the sun set, and, fifty minutes later, walked off the ramp into the darkness, carrying our backpacks. We didn't know exactly where the local Inn was, but the clerk had said, "You'll find it." We followed a woman who was pulling a suitcase on wheels, jittering over the rough road, hoping that she was going to the Inn. We might have been following her to her cabin, but we didn't mind. We were living slowly.

Sure enough, she drew us through wrought-iron gates to the Galiano Inn, complete with cedar shakes, tall tree posts, and, through the door to a vaulted space with a stone fireplace. We had arrived.

The next morning, we woke up to see the sun rise over Mount Baker, watched the large ferries plough through Active Pass, and laced up our boots for the day's walk. We had left our car, and our bikes, at home, opting for an even slower pace around the island. After breakfast, we walked to the Bluffs, explored the cedar forests, waved at llamas, watched the eagles soar, checked out the local organic food store, and, 15 miles later, returned to the Inn for a good soak and a read (about the Camino de Santiago de Compostela.)

The next day dawned with sunlight streaming across the harbour. Most of the other people staying at the Inn would be spending their day in the spa having hot stone massages and facials. But, that's not our style. So, we told the clerk that we'd be hiking to Montague Harbour. She had a quick intake of breath, "Oh, there's some wicked hills! You're walking? Really?" Being a mapmaker's daughter, and daring enough to interpret those lines on the map, I took a guess and said, "Let's head clockwise. I bet there'll be less hills that way." (Boy, was I gambling!)

Am I glad we didn't go the other way!!!

As it was, the hills were still a challenge. But, we just kept in mind that we were on foot, and not grinding our way up those hills on our bikes (or on the Santiago de Compostela pilgrimage!) We had time to stop, think, listen to the wind in the trees, watch the misty rain fall, feel it on our faces, wrap our scarves more tightly, gaze at the sandstone cliffs and the erratics at their feet. It took two hours to hike to the harbour, where we ate caraway cheese and stone fennel crackers on the shell beach. We didn't meet any other pilgrims on our trail, just a lone cyclist on a 40 degree hill, pretending to be Lance Armstrong on Mont Ventoux.

After four hours on the hike, we could feel each muscle working to keep us going. No pain, just good hard work. Our legs seemed to work independently, keeping pace with each other. We held hands at times. We tucked out hands in our pockets when we needed. Then we saw the rain heading our way. It came as a mist bank, white and blanketing the hills. We knew there was a pot of tea close by, at the Market Cafe, and reached the cafe just as the downpour started. A roaring fire, four throbbing legs, two cups of tea, and chocolate. Slow hike rewards!

An hour passed, and the rain softened. We ran across the street to the locals' trail to Sturdies Bay, only two kilometres away. This was our third passage of this trail, so we felt like we knew its secrets already, knew where the fern grove was, where the boggy sections were, where the people were gathering firewood, where we needed to take small steps to easily climb the steep sections. We felt like we belonged.

At the end of the trail, and around the corner, we treated ourselves to a visit to the local bookstore. It's one of those places that has reviews glued to the shelves - "John's pick", "Jennie's favourite". I bought "French Toast: eating and laughing your way around France." My husband bought "The Wisdom of Donkeys: finding tranquility in a chaotic world." Two slow life books.

Later that night, after we'd left the island by ferry, and arrived home, fully refreshed, the stragglers of the baby clump decided to arrive. Two babies came over the next three days, one after the other. We'd only been home for five minutes when the first phone call came. "Jacquie, I think the baby's coming!"

I smiled, changed out of my hiking boots, put on my birth gear, and headed out into the night. I loved our Slow Escape, but I also love Slow Birth (and those unpredictable clumps of babies!)

- Jacquie Munro, Vancouver Doula, Slow Birth, Slow Planet

Slow Denial

I promise my clients that I will always tell them the truth about what's happening during pregnancy and labour...but I must admit that I do downplay things during prelabour. Now, this is only to help the clients to make it through the crazy unexpected early stuff that really, REALLY, isn't labour.

This is the denial phase of labour.

Too often, people have the TV image of labour - your water breaks, off you go to hospital, get the drugs, and the baby is born on the bed (surrounded by gowned and gloved anonymous people). This may be what 90% of births are like...but they're not the kind of births that my clients have. They dare to be different. They live in denial. This is Slow Birth at its best.

Grandmas-to-be call and inadvertently pressure their children, "Why aren't you at the hospital yet?" Friends call and say, "I had my baby last month, and it was hell. Just go in now and get the drugs!" Labour will never progress with all those phone calls coming in. So, please, unplug the phone. Or, at the very least, record a new voicemail message that says, "No, we haven't had the baby yet, and we'll record the great news as soon as we meet our baby!" Then, turn off the ringer...and live in denial. (Oh, and you can strap on your TENS machine at this time, if you like!)

Denial works! One woman had her mum over for lunch when she was in early labour, and didn't even tell her. Then she headed out to rent a DVD, and planned to watch it that evening...and didn't even believe it when I showed up and said, "Now - you're really in labour. You'll have your baby in the car if we don't hurry!" (She had her baby a couple of hours later.) Denial worked so well for her (too well!) that we didn't have to play that game when she had her second baby.

A wonderful client had her baby last night (Tuesday night). Her "denial phase" started on Monday night. She called to say she was having mild cramps at 8:15pm. Now, I had a feeling that this might morph into labour, but I wanted her to be able to have a good night's sleep. So, I said that this could become labour, but it also could just be part of the normal changes that occur in the last few weeks of pregnancy. "Deny it, have a lovely bath, then climb into bed," I said. "This might stop, and the baby might not come for another week." She answered, "I do denial well! Sounds good to me!"

The next morning, she called to say that she'd done a great job of denying the contractions through the night, and managed to sleep quite well. Yes, the contractions had come every 10-15-20 minutes, but she pretended that this was totally normal, and she didn't waste any emotional energy on the contractions. By morning, she was feeling good, sounding bright and energized. Denial had given her a good night's sleep.

To make sure that she didn't have to do another night in labour, I suggested a good long bath after lunch. Her husband turned on music, and she had relaxed in the tub and chatted and laughed with her husband and sister. They made a great memory. They were living outside of time. "The bath was a turning point," said her husband. They didn't have to deny the labour any longer. After the bath, the contractions were 5 minutes apart and getting stronger and longer.

Are you noticing that this is a Slow Birth story? By playing the "denial game", they didn't focus on time, and allowed the body to rest and do its thing at its own pace. They were connecting as a family, and rediscovering that it's okay to trust the body's rhythm.

After the bath...after becoming so relaxed and soft, her labour began with strength and power. It wasn't long before we all headed to the hospital. The denial phase had lasted about 18 hours. We didn't count that as part of her labour. We started the official labour clock at 2pm. She started her labour happy, rested, emotionally strong, thanks to denial.

For the remaining 9 hours there was no need for denial. She could just inhabit her labour and let it advance slowly, at its own place. She danced, bathed, lunged, yoga'd, bounced the ball, stomped her feet, and sang. She only had one medical assessment during all that time. No one declared her "fully dilated", no one offered drugs, no one made her get on the bed...she just WAS in labour, without time, without judgement.

And her baby came with joy, her two feet planted on the ground. She was lovingly supported by one proud and amazed man, and four smiling women. Yes, she stood to have her baby, and clutched this little girl, called Lily, to her chest, laughing, "I don't believe it!"

Slow Denial had worked its magic!

- Jacquie Munro, Vancouver Doula, Slow Birth, Slow Planet

Tuesday, March 03, 2009

Prodromal Girls (or how to have the perfect Slow Birth)

Prodromal labour was the name of the game this week. Four babies were born, who each gave their mums long prodromal labours (and some long active labours, too.) None of the births were "easy" this week. But they were all amazing and beautiful and triumphant.

What's prodromal labour? It's Slow Birth at its ironic finest. It's that part of birth that isn't really labour yet (patience, patience). It's the body trying to deal with something without making it too challenging for the mum. But, the body doesn't realize that the mum has a brain (a very intelligent and 21st century brain) that continually tries to figure out what's happening...why is this taking so long?...why am I not having a 2 hour labour?...when will it pick up?...why? All those questions are exhausting. Prodromal labour demands that we honour the needs and rhythms of the body, and shut down the thinking brain. Prodromal labour forces the reptile brain to kick in. My job is to remind the mum that she must trust her body and baby...they both have their reasons for taking their time.

To us mere mortals, long prodromal labours can be challenging and undecipherable. However, to the four babies this week, the slow progress made perfect sense. They tried to give us their messages, and we did our best to interpret them. We promise to remember the lessons we have learned this week, and listen even more closely to the babies in future!

So, what was going on for these babies?

Baby #1: "Ooops...Who knew you couldn't come out forehead first? No one left directions for me! I thought it was a creative option! (They had to back me up and take me out, OR-style. Mum and dad didn't fuss about the change in plans, because I'm just too darned gorgeous!)"

Baby #2: "Hey, mum, I had my hand smushed against my face! And that cord kept getting in my way! I'm glad you gave me time! (I had fun being born in the water, it really helped make more room for me, and I made sure I slid out without tearing my mum, and, and, my hair was washed as I came out!)"

Baby #3: "Okay, if you only knew that I was 9lb14oz, you guys would have given me a break and been okay with the hours that it took me to figure out the best way to slide into the world! (Those people catching me all thought my shoulders would get stuck, but nope, I just needed to take my time so I wouldn't hurt my mum.) "

Baby #4: "Now, you have to understand what it was like in there. I had to twist my head this way, tilt it to the side a bit, just like that, then I thought, maybe, just maybe, I could mold my head into a banana and slide out mum's hip. (Oh, I forgot to say "Thanks" to the obstetrician who used her tiny fingers to turn my head into the right position. It was a breeze after that!)"

Now...we're waiting for Baby #5, who has yet to arrive. This baby may or may not be very overdue...who really knows for sure? We'll just have to wait and see...

- Jacquie Munro, Vancouver Doula, Slow Birth, Slow Planet