Bountiful Beautiful Blissful

It's August, so I am leaving for a month in Scotland without my pager...what an amazing concept. Being on call 24/7 can take its toll. Think of those lucky ones who are due in September. They will receive a fully rejuvenated me! And I do hope I don't come home to find my backup was busy with everyone! Fingers crossed!

While I'm away, I hope each of you takes some time to browse the shelves at Banyen Books. My favorite book of 2005 is "Bountiful, Beautiful, Blissful", by Gurmukh. Don't be scared off by thinking it may be too flakey - it's not, and incorporates many of the words and concepts that I use when working with pregnant and labouring women (I even sang "Row, row, row your boat" to myself during my second labour in 1987). When I read Gurmukh's book I feel as if she and I know each other intimately, and have been using each other's phrases for years. So, have a good read!

- Jacquie Munro, Vancouver Doula

Jacquie Munro - Vancouver Doula

Doula - n. a Greek word referring to an experienced woman who helps other women. The word has now come to mean a woman experienced in childbirth who provides continuous physical, emotional, and information support to the mother and her family before, during, and after childbirth.

I help you to realize that you have the abilities, wisdom and courage to give birth. Birth is something that you know on a basic level. I just help you to access that knowledge.

My care includes:

• 2 prenatal visits for teaching and planning
• pre/post-natal telephone consultations
• physical and emotional support during labour and birth at your home and/or hospital
• written birth notes
• 1 postpartum home or hospital visit (and unlimited postpartum phone calls!)

The Research
When a doula is present, it results in:

• a 25% reduction in the length of labour
• a greater than 50% drop in cesarean sections
• a 60% drop in the mother's need for epidurals
• a 30% reduction in the mother's need for other pain medications
• a 40% reduction in the need for oxytocin and forceps
• a higher incidence of breastfeeding success

Some investigators theorize that stress hormones cause the labour of many mothers to slow down, making complications more likely and the labour experience more stressful. By reducing the woman's (and her partner's) fear through calm reassuring words, touch, and relaxation techniques, the doula helps to moderate these reactions, ultimately lessening the need for medical interventions and shortening the labour.

How can I help?
As your doula, I am the person who helps you to understand the rhythm of labour and birth, who comes to your house when your labour is beginning to intensify, who helps you to find comfort, and reduces your fears. I work with you and your partner, teaching you both to understand the wisdom and the logic of the body, so you can recognize and accept the changes in labour. I encourage you to move, to take showers, to get into just the right position for your baby. I can help with relaxation and massage, taking turns with your partner, so that he or she never becomes too tired. Whether the labour is straight-forward, or you encounter the unexpected, you should both feel empowered by your ability to make informed choices. The effects of a positive birth experience can immeasurably increase your self-esteem, and strengthen your relationship with your partner and baby.

To the Dads: I am your resource person during the birth. I can explain what is happening, what you can do to help, how you can effectively work with your other caregivers. One dad described me as a choreographer. You both do the dancing, I just help you to look good! Or you could see me as the best waiter you've ever had, always knowing intuitively what you want next, or when you both need privacy!

During your Pregnancy: I will meet with you both to discuss your hopes, dreams, and concerns. We will talk about your own best ways of coping with pain and fatigue and how you and your partner foresee working together, and with me. We will discuss roles, expectations, comfort measures, and the rhythm of labour. We will build on the information you received in your prenatal or yoga classes.

You can phone or email me at any time with your questions, or just to chat. I suggest that you call before or after each prenatal visit with your caregiver. Our contact will usually increase as your due date approaches. During the on-call period (two weeks prior to and after your due date), I am generally available 24 hours a day, 7 days a week. I will give you as much advance notice of times when I may be unavailable due to illness, birth conflicts or planned vacations. To cover those times, I call on other experienced doulas for back-up. You do have a choice about whether you use the back-up, or which doula you'd like.

I strongly encourage you to develop and maintain a trusting relationship with your physician or midwife. Discuss with your caregiver what you expect from her, and what you expect from me, your doula. This goes a long way toward creating a positive birth environment. I am happy to meet with your caregiver in person or over the phone at your request.

When you are in labour: I prefer that you call me as soon as you think you might be in labour. I can reassure you, answer your questions, and make suggestions over the phone. Together we will decide if I should come right away or wait for further changes. I usually need one hour to reach you. Depending on your labour, we may meet at your home or at the hospital. No matter what, we will remain in touch with your caregiver or hospital during early labour, for safety. Except for extraordinary circumstances, I (or my back-up) will remain with you throughout the labour and birth.

After the birth: I usually remain with you for one or two hours after the birth, until you are comfortable and your family is ready for quiet time together. I can also help with initial breastfeeding if you wish. I am available for phone consultations during the postpartum period to answer questions about the birth or your baby. I will visit you at home or hospital within the first 8 weeks to see how you are doing, to review the birth, and to give you the birth notes. If you think you might need help in the weeks after the birth, I can make a referral to a postpartum doula.

As a doula, I do not:

• Perform clinical tasks such as blood pressure readings, fetal heart checks, and vaginal exams. Your physician, midwife, or nurse will provide that service.
• Make decisions for you. However, I will help you get the information necessary to make informed decisions, and be your advocate.

Fees: My rates are available upon request. There is an initial non-refundable booking/prenatal visit fee due when you select me as your doula, plus a birth fee which is payable within two weeks of the birth.

Please Note: I will make every effort to be at your birth. If I am unable to attend your birth or provide back-up due to circumstances beyond our control (e.g. emergency cesarean, unforseen illness, etc), you will not be charged the birth fee. However, I will retain the booking/prenatal visit fee, which covers the cost of prenatal visit(s), phone calls, and handouts.

I look forward to working with you!

- Jacquie Munro
vancouverdoula@gmail.com

Every birth is an adventure.

No matter how many times a woman has given birth, she is setting out on a new experience.

I hope to support you during this life changing time, and help you to create a positive memory of your pregnancy, birth and postpartum experience.

This is what it's all about

"Mi muchacha salvaje" My wild girl

Birth is something you know. Can you imagine arriving at the age of 30, and having your body throwing you an entirely new experience - something without a reference point? It’s just not that nasty.

Birthing is a lot like lovemaking...and Buddhist teachings, for that matter. It involves surrender, letting go, release, acceptance, and total trust. It also involves passion and power, which, for some, can be overwhelming. For others, it can be a process of awakening, change and growth.

Yes, birth is like lovemaking - and the majority of people would think there was a world of difference between birthing sounds and lovemaking sounds. But there isn’t - they are both an expression of intense creative power. The only problem is that I’m so used to birthing sounds that I only categorize groans and moans as birthing sounds. This can get me into trouble. Oh, dear!

So, there I was - on a walk with my husband last summer. The heat was so thick that it hummed. All doors and windows were open to the still air. Walking past a house, I heard the sounds of a moaning, panting woman, “Oh, GOD! Oh, GOD!”

“Bob...I’ve got to go help her!”

“Sweetie, no - She needs no help.” Why does he have that smile?

“No, Bob, you don't understand. She sounds like she’s about 5-6 centimetres. Maybe they’re worried they won’t get to the hospital in time!” I was so anxious, I was ready to knock on the door.

“No, dear, she’s fine - let’s keep walking.”

Then silence in the heat...

OH, MY!

Sorry...

She wasn’t in labour.

Thanks to my husband for being so wonderfully understanding and accepting of my focus on birth (sigh!).

Birthing and lovemaking are psychosexual processes. Most women aren't fearful of lovemaking, though the experience can be overwhelming both physically and emotionally. There's a loss of self, a letting-go, a transformation of the perception of space and time, and the knife-edge of pleasure and pain. The sounds we make are deep and open. However, if consent is not given the experience leads to pain, anger and emotional damage. For birth to be as open as consentual lovemaking, there needs to be consent given by the woman to her body. She needs to consent and surrender to this powerful psychosexual process. She needs to trust her body.

Birthing is truly something that we are prepared for on a cellular level. But our twenty-first century brains fight for supremacy over the reptile brain within us. We try to label and time and impose a structure on this force which is all about fluidity and stillness of mind. Yes, there will be a struggle within the mind and body, but eventually there needs to be acceptance and a surrendering to the body’s knowledge and power. The length of that struggle is what determines how easily we birth.

Now, of course, this is assuming that all is well physically, and the baby hasn’t decided that today he is going to try to come feet first, or elbows above the head, or sucking both thumbs. Yes, there’s the wild card baby at play. It’s not just about the mother. We have to trust that the baby is an active player here, pressing and wiggling the head against the mother’s muscles...pushing his feet against the top of the uterus. And we must trust that the baby will wave a big red flag if there’s trouble. Trust, acceptance and surrender are involved here. The baby is wise.

So, how to prepare for this wild ride? Live in the moment, look into your love’s eyes, experience passion together, trust each other, walk on the beach together, make noise, dance, read, sleep, trust your body, laugh, let your mind be still. And know that you will come out the other side a family.

- Jacquie Munro, Vancouver Doula

...the way some collect spoons

After the Birth

in her mind
she goes over and over the details,
how, close to the end,
she could no longer stand
the sound of her husband's breathing,
the pain
and the need to keep pushing
long after the baby was out
and the midwife gone

months later,
she still wants her husband
in bed late at night
to tell her once again what happened
but he is tired of broken sleep
and the crying babe
so she turns to other women
and collects birthing stories
the way some collect spoons

I'm home from a birth that spanned the night. Driving through the dark, I saw the husband turn left on yellow, wheels spinning ahead of me. She walked through the shushing doors and slowly lowered her body to the floor. - Are you feeling pressure? She nods. Husband with tears in eyes. Woman low moaning, rocking , swaying, hand tracing circles in the air. Ready to push so soon. In her own room now, windows open to the dark night. Birds singing at 2am. Such power. Then blocked by the power. Moving sitting, kneeling, no use, can't push, squatting, no good, standing, pushing in the chest. I shake her hips and she surrenders to the deep power and slides the baby down, body opening, and out into her arms. Dad streaming tears. Mum laughing laughing laughing... "Sophia!"

- Jacquie Munro, Vancouver Doula

So, what’s the best birth book to read?

In 1982, I was obsessed with everything to do with babies. I ducked into every book store for months before I got pregnant. You’d find me sitting on the floor by the Pregnancy and Childbirth section, surrounded by books. These weren’t “Earth Mother” books. I started with the encyclopedic books, looking for the ones authored by doctors with the most letters behind their names... FRCP, etc. You know, the books which scare you half to death with descriptions of all possible things which can go wrong. Then, I went to the university medical bookstore to look at obstetric textbooks. I even studied an obscure Swiss method of breathing for labour, which I photocopied from the main library. This method left me exhausted, out of breath, and very, very confused. It didn’t help when my husband and I went to prenatal classes and pretty much “failed” breathing. And when the nurses at the hospital asked us what our “birth plan” was, we just said “to have it go well”, and then I asked if I could blow-dry my hair before the obstetrician started my induction. Yikes! Over-prepared with book knowledge....under-prepared with inner knowledge.

Then, when I was pregnant for the second time, I found that reading C.S. Lewis’ “The Lion, The Witch, and the Wardrobe” to my daughter brought so much more inner peace and contentment. I was working with midwives this time, and my visits were filled with laughter, and great book recommendations. I read Elizabeth Noble’s “Childbirth with Insight” which teaches you to trust your inner wisdom, Ina Mae Gaskin’s “Spiritual Midwifery”, which, once you get past the now-quaint 60’s language, is a deeply truthful account of birth, and anything by Sheila Kitzinger. My midwives reminded me that I didn’t need books to teach me how to give birth. They said I needed to trust my body, and to visualize a positive outcome. So, this time, you’d find me sitting with my daughter on the floor of the Children’s section in the bookstore. I bought books with beautiful illustrations, mystical children’s books, books which fed our souls. And when I went into labour, I trusted my body, danced with my husband, and experienced childbirth with joy.

After what seems a lifetime as a doula, I spend more time discussing recent book group titles with my clients, than recommending so-called “birth books”. Most clients say that they’ve not read any birth book which truly speaks to them and their experience. So, I recommend books which will help them through their journey. One woman, who was an engineer, had to leave work because of high blood pressure, and wanted to know how to slow down and face the looming prospect of 5 weeks on bed-rest. I asked her husband to pick up the first of the “Outlander” series by Diana Gabaldon, a good historical “bodice-ripper”. After a week, she called to say she had finally found a book which could keep her glued to her seat...and “what’s the next title in the series!” By the time she went into labour, she had slowed down, and, in the process, learned so much about herself.

When I walk into clients houses, the first thing I look at are their bookshelves. I can tell so much about each couple by seeing what books are prominently displayed. Ah, she must have been an English major... Ah, he’s an engineer interested in science fiction. And there, on her bedside table, is a copy of Harry Potter. One couple were concerned about their baby being born “different”. Should I mention “The Chrysalids” by John Wyndham, a science-fiction novel which explores the nature of “difference”?

Should I recommend “The Giver” by Lois Lowry, to people who are looking for the “perfect pain-free birth”? In this children’s book, “Jonas’s world is perfect. Everything is under control. There is no war or fear or pain.” Once I broke free of the confines of “birth books”, I was free to help women prepare for birth in a way which honours them as individuals, which works with them in a much more holistic way.

Birth rips off all blinkers, exposes us for who we really are, forces us to face others without masks. We cannot “prepare” for this encounter with ourselves. We can only explore our inner selves as much as possible before the labour comes, and trust that birth is something we know on a basic level. I truly believe that reading for pleasure helps us to achieve a trance-like state, and, allows us to see ourselves mirrored within the pages of the book.

See what books speak to you...

- Jacquie Munro, Vancouver Doula

We are the Doorways of Life

“‘Breathing for a hollow organ’ works well in labour. Breathe in...breathe out. Allow there to be space after the out breath, a time for nothingness, for the hollow organ to be still. Then wait for the body to take in the next breath. Listen to the sound of the breath as it goes in and out...circular, whole.”

This is the centre of labour. The breath is a reminder that there is continuity in all things. There is safety and surety in the breath which goes on and on throughout the wild storm of labour. Even when the labour reaches the point at which it can be called “white lightning”, the breath is constant as ever. And in the quiet times, between contractions, the breath is soft and open.

“Breathe in strength, breathe away the fear. Listen to the sound of the breath...in and out. Each breath takes you closer to the end of a contraction. Then comes a deep breath, down to the ground, and a long slow sigh...which brings quiet and rest.”

Around the central core of the breath is the movement of the body. The body rocks and sways in rhythm with the breath. Kneeling and squatting, leaning and dancing...the body moves as it wants. At times it wants stillness and rest. At times it wants to match the intensity of the power within. The hands trace circular patterns in the air. The toes point, as the feet trace the patterns of a dancer.

“Allow your breath to take you deeper and deeper inside yourself. Allow your breath to make music. Your sounds will sing to the baby. Your body will rock the baby. You are safe, the baby is safe.”

Deep into the labour, the trance comes. Space and time alter. The mind accepts the power of the event, and the breath continues at the centre. One breath, one breath, one breath. Live in the moment. The body opens. In the spaces between contractions there is sleep and dreams. The breath takes form and becomes a voice, a sound, a song. Round and open, the “ohhhh” of labour begins.

“Picture the baby, chin on chest, deep down, wriggling to find the perfect fit in the cradle of your pelvis. Feet press against the top of your womb, helping the baby dive down, down towards the light.”

The “ohhh” sounds open the throat, open the vagina. The labour now has a rhythm, a form, which is known and safe. The power gathers and intensifies. Yet, around the woman, there are hands to hold her, hands to stroke her, echoing the rhythms of her body. The room is dark, the voices are calm and quiet. She knows she is safe. She lives in the moment. She lives with her breath. Time and space mean nothing. Her circle of awareness has become smaller and smaller. Only the eyes that look into hers matter. Only the voices that hear her whispers matter.

“Soon, you will feel a deep pressure at the peak of the contraction. That is safe. You’ll want to fight against the urge, or to push with it...but you will breathe deeper, more open. Listen to the sound of your breath. Let the baby press down, let the body change from opening to giving birth. Your mind will rebel, but your body will know what to do. Trust your body. You are strong. You are safe, your baby is safe.”

And the moment comes when the power is confusing. The rhythm is dashed and ragged. The eyes are wide...

“My baby is coming!”

The power shifts, the trance is gone. The ‘feminine’ opening part of labour has ended, and the ‘masculine’ pushing part of labour begins. The hands pull, the body curls, and the baby presses deeper. The feet need the firm ground to press on...bare feet on hard ground. A deep squat, eyes closed, hard work...then rest. A growl escapes the throat. Everything in life is present at this moment. Pain, pleasure, joy, acceptance, struggle, love, fear, patience, anger, power... At this moment the door between life and death is wide open. The woman as she knew herself is gone, but in giving birth to a baby, she gives birth to a new woman. In giving birth, both a mother and a baby are born. And she is safe, and her baby is safe.

“And it comes back to the breath, with joy. The baby’s breath comes, the soul is strong in the body.”

- Jacquie Munro, Vancouver Doula

Mindful Words

Picture a birthing room. A woman is leaning over beside a bed, and the voices around her are saying...
“You look so tired!”
“That baby isn’t very happy.”
”It can’t possibly be time for you to push yet.”

She drops her head, and cries...

The language that we use in the birthing room touches a woman deeply. When in active labour, a woman is so open to suggestion that any negative word can sap her energy and make her want to give up completely. Her negative emotions can then slow down the labour, or cause complications that would never have happened if those words had never been spoken.

Picture that same birthing room. The woman is leaning over the bed, and the voices around her are saying...
“You’re so powerful...I know it must be hard, but you can do this!”
“Your baby’s head must be coming down for the heart rate to drop then recover so quickly. That’s a good sign!”
“Trust your body...it will tell you when it’s time to push.”

The woman lifts up her head, and smiles...

Smiles in a birthing room? You must be joking! Well, there can be smiles and laughter, and incredible joy. But you don’t hear about that side of birth. People want to tell stories of blood and pain, exhaustion and tears, doctors’ golf games, needles, and drugs.
No one dares mention that there can be joy during labour. You might laugh at them!

Studies have shown that women never forget their birth experiences. They often recount stories of their births using the exact words spoken by caregivers. One eighty year old women recalls the head matron standing in the doorway with her Great Dane, saying, “You can’t possibly be ready to give birth. Stay in bed. I’m far too busy. The dog will stand guard.” Another woman questioned her obstetrician about the need for a cesarean, so he asked, “Do you want to have your child taken to school in a Funny Bus?” When I found out I was pregnant with my second child, and questioned the need for a vacuum-assisted delivery at my first birth, my physician said, “Well, what did you want...a dead baby?” The start of my path towards empowerment came with that doctor’s question. I stood up, left the room, and slammed the door. I hired midwives for my second birth, wrote a letter of complaint to the doctor, and worked to surround myself with positive words. The language that people use can hurt us, but it can also heal us.

Most of the language used in hospital birthing rooms is medical, masculine, and certainly not positive. “Incompetent cervix”, “elderly primip”, and “trial of labour” are a few phrases which make women feel less than capable. Women don’t “give birth”, they are “delivered by the doctor”. In the hospital setting, women find themselves using prison-terms to describe their stay: “I was released” or “They let me out”. Falling into the role of patient, the labouring woman starts to ask permission to go to the bathroom, to move, to make noise, undermining her own body’s natural inclinations. When I was in labour with my daughter, I automatically got into the hands and knees position. My body knew that this was the best position to help my daughter turn and fit well into the cradle of my pelvis. I started to rock and sway and hum. I was coping well. Then a new nurse walked into the room and said, “Well, that’s a weird position to get into!”, and shook her head. Being vulnerable and open to suggestion, I turned over, sat down, and lost my ability to listen to my body. The body speaks to us in labour. If everyone else was quiet, maybe we could hear the body better, and perhaps there would be less medical intervention.

Perhaps the most wonderful example of this came at a birth I attended many years ago. The labouring woman was deaf. She didn’t use sign language, and would generally read lips. However, during her labour, she closed her eyes, finding comfort in an internal focus. She said she loved to hear her body talking to her in the labour. Her husband and I communicated with her by using our hands - to touch, to stroke, to hold, to hug. She laboured beautifully, accepting the wisdom of her body, and gaining strength through the calmness of our hands. Ah, but the nurse kept trying to tell the woman what to do from behind - always forgetting that her words would go unheard.

During labour, a woman goes deep into herself. One father described this basic instinctual process, “Getting in touch with her reptile brain”. As support people, we should do whatever we can to nurture that process, but quietly, and one at a time. The “reptile brain” can’t deal with many voices, many demands. Quiet, confident messages whispered into her ear can really help. “You are strong”, “You are safe”, “Your baby is strong”, “You can do this”. Encouragement from many voices may seem helpful to the supporters, but to the labouring woman it can seem demanding. It can reinforce the feelings of self-doubt - “Am I doing okay?” “They’re all calling to me because they know something I don’t know”. Quiet presence is more strengthening. One woman who had her baby last week, said that it became very confusing at the end, because a number of new people entered the room and started telling her what to do. Then she felt my hand reach for hers and heard my voice, quiet and calm, in her ear, saying, “Just block out the voices and breathe out your baby. Open your eyes and see your baby.” So, instead of being confused, she said she gained clarity, and time stood still. She opened her eyes, and breathed her baby out - watching the whole thing. She was also so fully present that later described being able to feel the baby’s head, shoulders, arms, hand, and hips, as they came through her and out into the world. What joy!

By being mindful and gentle with our words, we can help women give birth with joy. This doesn’t mean that there won’t be a struggle, or pain, or moments when she will doubt her ability to continue. This just means that we won’t be making her journey more difficult by using words which add to her struggle. Rather than demanding, “PUSH!”, we can empower a woman by saying, “Let your body open...breathe the baby out...you are strong...you are safe...” The long-term effects of those words are immeasurable.

- Jacquie Munro, Vancouver Doula