Two baby girls in 24 hours

Well...it was a busy day. LL's water broke late Monday night (first baby), but there were no contractions immediately. She said that she'd try to sleep and call me in the morning. Only a few hours later, the phone rang. I answered, thinking that the contractions must have started quickly...but it was LF in labour with her third baby. I knew she was going to be quick, so I crossed my fingers and headed off to meet them at the hospital.

This is always a dance for a doula...two clients at once. I knew I had backup at the ready, but I felt pretty sure that I'd be able to make it to both. I just had a feeling... I decided not to panic.

At about 5am, I was at the hospital with LF. She was at the "I really don't like this any more" point, and feeling more "pushy", and I knew that the baby would be born around breakfast time. My phone rang...it was LL's husband. They'd started contractions at about 3:30am but had held out, wanting me to get a good sleep. Ah...but I was already up and deep into another labour. I reassured them that my backup (daughter Sarah) would be there as my mini-me within 20 minutes, and that I would follow, probably around 9am.

Well, it miraculously worked out just like that. LF's baby came in pretty much one smooth push...amazing...beautiful. The staff were attentive and trusted her through and through (not even a vaginal exam to confirm full dilation - just a trust in the mum's own body wisdom) and the baby came so sweetly.

Not long afterwards, I heard from Sarah, "We're heading to the hospital" (not the same hospital that I was at...of course). I hugged the new mum who was still glowing (can I tell everyone that you're an amazing 50 years young, LF?) and headed through the slippery snow to LL. I found her in her apartment lobby, hugged my daughter, and followed LL and her husband to the hospital.

After a quick assessment, we headed back to their home for extended shower time, then returned to the hospital hours later...and thankfully qualified for a beautiful room (5+cm dilated will get you the "Hilton").

Now, earlier in the morning, LL had told Sarah that she had a feeling that the baby's hand was up near the head. Well...12 hours later...after hours and hours of powerful pushing (we really pulled out all our tricks) we saw that baby...right arm crossing her chest and her hand up by her left ear. LL had managed to push out that baby, despite one of the more challenging compound presentations ever. She DID IT!

Two triumphant mums. Two beautiful girls. One thrilled doula...who tumbled into bed exactly 24 hours after she woke up. What a fabulous day!

Thanks to all the amazing staff who went above and beyond to help these two mums have the best experiences ever. And to the amazing doc who helped us squeak out the "let's think outside the box" baby...you are truly gifted. Thank you for trusting birth - completely.

- Jacquie Munro, Vancouver Doula

Myth #783 - Birth is Scary

After she had her baby the other day, this new mum said, "You know, once you're in it, labour isn't scary! You just do it!"

I have so many clients who have carried the fear of childbirth with them for years and years. Some even postpone the event for as long as possible, just because their friends (or families) have told such horror stories over the years.

I tell my clients that our bodies aren't going to spring something TOTALLY NEW on us when we're in labour. Birth is something you know! Contrary to popular belief, labour really feels like period cramps, low down, way down there, NOT all over your body. And it comes and goes (unlike period cramps which are continuous and can last for days). Yes, it gets very strong, but, as long as the birth is normal and you have continuous support, it is totally do-able (not totally fun). (Remember, the World Health Organization believe that 10% of birth should be cesareans, no more. That means that 90% of births should be "do-able".)

Surprisingly, labour can be frustrating, even BORING, at the beginning. Your body hasn't taken pity on you and started the endorphin surge yet (ah, when it comes, SO good). Until those endorphins kick in, you're fully present, fully raw, feeling and thinking and using your left brain (nasty left brain). You start to think, "If it's like this now, I'll never be able to take it when it's 10 times worse." It shouldn't be scary if your doula is talking you through this part on the phone, or popping over to your house, if necessary. But, hang on, if birth is undisturbed (that's the key!), then it never gives you more than you can bear. Active labour begins, your endorphins kick in, and your body goes into auto-pilot...no thinking...you just "do". And you can do it!

Your friends probably found labour scary because they didn't have the assistance of a doula or midwife, didn't have an undisturbed birth, didn't work through their fears in advance...nine out of ten times you'll find that the couple were on their own, left to stumble through it alone. Now that's scary!

So, the other day, we headed to the hospital when her contractions were close together and very strong. Bloody show - check. Feeling pressure - check. Contractions palpate as strong - check! She was at the "frickety! frickety!" stage (as one mum described it). She loved standing by the sink, both at home, then at the hospital. We got through the passing request for an epidural (always happens at 5cm) and out the other side (I was thankfully backed up by our amazing nurse). As her labour progressed and the endorphins kicked in (big time!), her face became smoother, she began to sway her hips, she became calm and quiet. The lights were low. It was beautiful to watch her labour progress undisturbed. I knew everything would be fine.

This is a woman who had thought that labour would be very scary. But, with support, she found that this was something that she'd done so many different times over her lifetime - labour was a challenge which she could meet. She had the mental fortitude, life experience, and the tools at hand. Birth was something she knew. I don't think she'll be scared about anything again.

Crashing through our fears and our cultural myths is what's scary - Birth isn't.

- Jacquie Munro, Vancouver Doula

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

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

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

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

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

An Argument for Non-Linear Thinking

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

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

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

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

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

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

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

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

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

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

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

Totally non-linear. - Jacquie Munro, Vancouver Doula

L'Arbre et Le Fruit

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

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

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

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

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

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

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

Lessons from a Happy Flying Baby (Advanced Level)

Did I tell you that I think that labour lasts as long as you need to learn all the lessons required for this particular child? There’s perhaps a little extra time added to work through some particularly tricky past life experiences. The baby’s personality has a lot to do with this...

One of the family doctors I know, said that all three of her boys had labours to fit their personalities. One came flying so fast that his cord broke. And that’s how he goes through life - flying headlong into things (both physically and emotionally). Another son takes his time, considers all his options, then considers them some more. As a result, his labour took a long, long time.

My daughter is strong, powerful, never wanting to follow the crowd. When I was in labour, her head was trying to forge a new, totally different path - out my hip. Later, her high school math teacher said that she would pound away at a problem for a long time, only to later discover that if she just turned the equation around, the answer was there - and simple. That sounded just like her labour, since she eventually tilted her head, and came easily.

It’s interesting, but my clients who have the quickest births often have the hardest time adjusting to parenthood. They often tell me that they just can’t figure out their baby. In a 15-minute labour, there’s not much time to learn the lessons that you need to parent this child.

So, be thankful if you have a long, gradual labour. There are many benefits to the lessons learned during this time - lessons that you will draw upon for a lifetime. You might even begin to understand that labour and birth is something that’s out of your hands, and that's okay. When things are slow, it's not "your fault." It might just be your baby speaking to you through your body...

So, listen. - Jacquie Munro, Vancouver Doula

"window children/with protective parents/sit and watch/other kids go out and play"

When I had my daughter, obstetric ultrasound was relatively new. My British obstetrician proudly told the story about the Glasgow obstetrician who saw the potential in ultrasonic testing for cracks in submarine hulls. I had one scan late in my pregnancy because the obstetrician suspected that my baby was quite small. The images were unsettling – at 28 weeks, her body was too big to completely fit on the screen, so it appeared as if her legs, arms, and torso were unconnected. I left the room, shaken. After waiting for the results for a day, I heard that the verdict was in – she was growing normally. (Her birth weight was a decent 8lb 8oz.) Even with the good news, it was hard to reconcile those images with the feeling of her inside me.

To reconnect, I would press my belly against my husband late at night, so that he would be able to feel the baby move against his body. We would talk about who this baby might be, based on the clues that we had – the vigorous movements, the tumbling and dancing. We worked hard to leave the disconnected ultrasound images behind.

During my second pregnancy, I chose to be cared for by midwives who were part of a pilot project at Grace Hospital, and, as part of the project policy, I had to be seen once by a physician. His main focus seemed to be to convince me to agree to an ultrasound. “You’re not one of those midwifery patients who’ll argue with me, now, are you?” I remember my 3-year old daughter looking at him, warily, when he said that. “Oh, of course not!” I heard myself saying, submissively, while thinking, “I wish I was strong enough to opt out.”

Over the years, I followed the progression from 2D to 3D and 4D ultrasounds. During research trials of the 4D equipment, clients would describe the experience as eerie, like they were seeing something that they weren’t supposed to see. When I didn’t hear anything further about 4D scans, I assumed the newest models were being used under strict guidelines in medical diagnostic settings. But, when I started to hear that one of the newest pregnancy trends is the “Bonding Scan,” I couldn’t help being reminded of the trend to X-ray customers’ feet in shoe stores in the 1940s and 50s.

For some reason, the 3D and 4D ultrasound images have always made me feel mildly nauseous. It feels like the baby isn’t comfortable being scanned – moving away from the transducer, covering her face. But, after talking with many clients this week, I’ve found that I’m not alone. Each woman that I’ve spoken with (perhaps we’re all in agreement because, well…they are my clients) talked about a little voice in her head that said, “It’s like we’re looking at a mystery without permission.” “There’d be a porthole if we were meant to see this!”

Certainly, ultrasound images can reassure parents. They can see the fingers and toes and be sure that everything is “all right.” But, isn’t it a false sense of security that we’re being given? We can never ever be sure that everything’s “all right” in life. Ultiimately, we have to accept that there are hidden dangers, potential concerns, around every corner. Life can never be risk-free. As parents, we have to let go at some point, do our best to keep our children safe, and hope for the best. Certain things are beyond our control. This is the hardest challenge of parenting – to trust that we will do our best to ensure the safety of our children, teach them to keep themselves safe, then, eventually, let them go out into the world.

Perhaps my negative feeling about the “bonding ultrasounds” is my gut telling me that we have to trust our bodies and our babies. It doesn’t mean that we have to turn our backs on technology, just use it judiciously, mindful of the false sense of security that it gives us.
- Jacquie Munro, Vancouver Doula

"The only real valuable thing is intuition" - Albert Einstein

Oh...the remaining three babies...I never talked about them... Sorry! Here it is...

It's interesting how women often have a sense of how their labour will go, even weeks before the due date. Some women have dreams of a spider web (baby wrapped in cord) or a rock climber (cord again) or a square peg in a round hole (positioning problem.) Are these premonitions or self-fulfilling prophecies? I don't know. I like to think that the body is giving the woman a clue about what is currently happening, and that these dreams are reality-based, not fear-based.

The last three births in the marathon week mirrored their mothers' dreams and premonitions exactly. One had said that she wasn't concerned about the birth at all. Another had said that she had a hard time visualizing the baby coming out of her - there was some problem with that image. The third said she was feeling very patient.

Well, the first woman, a heptathlete, had the straight-forward first birth that she had envisioned - pacing around the house and hospital, squatting between her husband's legs for her baby's birth. Pure and simple. No muss no fuss. What joy!

The second woman laboured beautifully at home, made a smooth transition to the hospital, and sunk into the tub on Holly. Her labour had looked like it was accelerating normally, but whenever I talked about the baby sliding down, she'd jump in with..."No, don't say that." It was as if she knew it wasn't safe to imagine the baby descending. It turned out that the placenta had partially abrupted, and the baby needed to be born by cesarean to stay safe. I truly believe she had known there was something going on at an intuitive level. There's no better lesson to learn as we head into motherhood - that we can trust our instincts. Amazing.

During her pregnancy, the third woman had been so accepting of whatever labour might throw at her. She seemed so calm, trusting in her body. She had a long slow prelabour period, and surprised the doctor by showing up for a prenatal visit...at 7cm! Even though it took a further 10 hours before the baby was born, she remained patient throughout. She took in everything that I said, her husband said, her nurse said, her doctor said...trusted her body, did what she needed to do for her baby, and it all worked! Here's her account:

"Your confidence and coaching really worked for me - I kept remembering you saying that it's all in the mind and that it's safe to go further. Every tip you gave me, whether it was working through a contraction or a push, made so much sense. I could actually imagine myself climbing up the rope when you told me to do so.

My first birth experience has been so positive and amazing, and I should really credit you for it. It's just like having a personal trainer run with you through your first marathon. And I can now speak from firsthand experience that birth itself is not unlike running a marathon. I remembered how the crowds cheering on the sidelines, the bands playing, and the water stations, all gave me boosts of energy. You supplied the bands, the cheering crowds, and the sips of hydrating water when I needed them. Somehow giving birth to Allison seemed a whole lot easier than the marathon ... probably because I had my own support team for the entire journey! Thanks so much!"

So, these three women listened to their bodies and their babies, and had the births that were "just right" for them. This was a true testament to mother's wisdom...and a mother's intuition.
- Jacquie Munro, Vancouver Doula

George, Entropy (and the Second Law of Thermodynamics)

I always say that we can only hope for the best on the day of labour - that the baby is the wonderful and unpredictable 'wildcard.' So, we must trust our body and our baby to give us strong clues about what needs to happen, then make the best choices on that particular day, with the support of those around us...

Here’s George, introduced by his mother:
“George was born Feb 16th - I had the induced labour that didn’t progress well and a cesarean - and he turned out to be 11 pounds! Remember us? These women who labour in the park, cooking turkey dinners...well, humbug. Not at all how mine went, although it was totally great in its own way.”

Here’s my memory:
Okay, what I remember was a mum, close to 2 weeks overdue, whose contractions were like a jackhammer in concrete. They never let up! When I arrived at her home, she was leaning over the bathroom sink, dealing with one contraction after another. Though she was coping, these contractions were a strong message from her body, saying, “There’s something really big in here that I’m working hard to get out!” She needed help fast. When we arrived at the hospital, the nurse measured her tummy, and looked up at me with one eyebrow raised. This was one big baby! The contractions weren’t slowing down, and there’d been hardly any progress. It seemed to take forever, but the staff grabbed an epidural out of the toolbox (finally!), after which mum said, “I haven’t felt this comfortable in months!” When the option of a cesarean was presented after many hours of labour with no progress, and the baby’s head up high in the pelvis (another sign from the body), everyone came to the conclusion that a cesarean was the pragmatic option of the day. Rather than seeing this as a negative option, I saw this as a way to honour the body, and the baby’s personality - powerful, strong, spirited...

Back to George’s mum:
“Spirited is one word for it, original source of entropy in the universe is another. It is a great way to be, in life, I could use more of it myself...
So, George is 8 months old now. I think it has been fairly smooth sailing. He nursed well from the beginning. He never did get colicky, and has been very good natured all along, but it took us 6 months to get a daily routine with naps and feedings, and more than 2 hours between nursing, so I was feeling a little stir crazy for a couple of months there.

Anyway here we are. He’s still good natured most of the time, but not placid, really active. He's been crawling since 7.5 months, now pulling up to stand on anything taller than his knees. He is never, ever still - won't sit in your lap.

He used to enjoy diaper changes, because he used to love lying on his back and kicking and waving, and at 3 months he'd kick and wave for up to 20 minutes at a time! Now, though, he's the boy who's never still. He practically flies through the air. I often have to actually pin him to the floor with my feet on his shoulders to change a diaper, and it's really frustrating.

He's removed two doorstops (I had to remove the rest), the cap from the toilet bolts, and the cap from a childproof bottle of vitamins. He's working really hard on climbing the stairs and opening the closets. No trips to Emergency yet, but I think it is in our future.

We don't want to totally childproof the living area (there is a totally childproof area upstairs) - we'd rather have him learn that some things are out of bounds. But I get tired of redirecting him away from the lamp cords over and over again. He doesn't get that he shouldn't be chewing them, and I don't think he's developmentally capable of restraining his impulses. Any ideas?

Today he finally figured out how to use a straw, slurping up big mouthfuls of my club soda and letting most of it pour right out his mouth again. He generally finds that a fun trick. He'll take a cup, slosh in a big mouthful and spit most of it out through a big grin. I don't give him juice or we'd be really sticky.

He and the cat never quite worked out their relationship. George loved Lily, but Lily didn't love George. I had always assumed that a cat would just avoid the baby. Well, not Lily. If anything she would taunt him, coming up to the other side of the baby gate, just within reach, then swatting him if he reached out to her. Once he started crawling, she would stand her ground and swat at him when he grabbed for her, so I was having to supervise them both, keeping two mobile organisms away from each other. Finally, she went to live in a cabin in the woods somewhere in Squamish. Apparently Lily is having a fabulous time with no babies, and a big wild world.

So, in some ways it's easier than I ever thought, because I had quite an easy baby, especially for a newborn. In other ways, it's harder; I thought there would be some pattern to the days that would emerge, or that I could try to impose, much earlier than it turned out. I thought naps would be longer, and I'd be able to get more done. Next time, if I should be so lucky, I will be better prepared! I will have a postpartum doula, and a big stash of Clif bars, and I'll be good to go.

Now, I'd better get some sleep!”

Thanks to George's mum for being so wonderful and open and honest about the realities of labour and motherhood. If we laugh at any of the descriptions, it is only because we see a little bit of ourselves or our children in the images. The details are unique, but the struggles are universal!

“I know the heart of life is good…”

"Pain throws your heart to the ground
Love turns the whole thing around
Fear is a friend who's misunderstood
but I know the heart of life is good..."

I don't think John Mayer was thinking about birth when he wrote this song. But I played it over and over again on my drive home from a beautiful birth last night.

Why was this the song I needed to hear after such a joyous and swift birth? I just knew that this was going to be a powerful week. There was going to be sadness to balance the joy. I could feel the phone call coming...

“Is it normal if you don't feel the baby move at 17 weeks?”

And to think I bought the book about Spirit Babies just the other day. I’d been already preparing for this phone call.

Then, this morning, an email came from another wonderful, powerful woman, spilling over with loss and fear…

The Spirit Babies book was at my left hand, waiting for me to pick it up.

Later that morning, my pager vibrated as I sat having tea with another amazing woman, nursing her five-month old baby, finally shaking free of the fog of postpartum. I made a quick phone call.

A quiet voice on the phone confirmed last night’s fears. My memory flashed to images of her first birth, where she was strong, singing mystic songs in labour. She leaned over a bed, holding onto a desert herb, the kaff Maryam, or "Mary's Palm." According to Arab tradition, the Virgin Mary clutched this herb in her hand while "suffering in childbirth", its branches unfolding as her labour progressed.

On some days, when I’m working with clients, we skim the surface of life, talking about the technicalities of birth, what to expect, our biology, logistics…

But on other days, we’re almost forced to delve deep into the spiritual meaning of this thing called “birth.”

Today, I made phone calls, sent emails, and searched for meaning like someone in the desert searches for water. I need the kaff Maryam in my hand…so I can help these women through the challenges of this week.

Just as I had read the book on Spirit Babies only yesterday, then attended a joy-filled birth, before the new week began to unfold… we are all given the tools to deal with these challenges in advance – miraculously. Our hearts just need to be open enough to hear the lessons as they arrive, to make sense of it all, and to remember that “the heart of life is good.”

The Inner Journey of Pregnancy

During a client’s first pregnancy, I’m continually trying to think of the best way to help her prepare for this life-changing event. Over the months, we certainly talk on the phone about her physical changes. But her emotional changes, her expectations, values and priorities are of even greater importance.

Often, a woman’s inner wisdom is at odds with the societal standard, and my job is to help strengthen her confidence. I have to help her to trust her body’s ability to birth and shut out the voices shouting, “You really should have that test” “You’ve never done this before” “Everyone has a Diaper Genie” “Buy bottles in case breastfeeding doesn’t work.” The competing voices can almost drown out her “I can do this,” and weaken it to become “I’m naïve to think I can do this.”

To have an ideal first birth, a number of factors have to be firmly in place. A perfect example was recently outlined by a local midwife, who wrote “I know if I have a 28 year old woman who has not been sexually abused, who really wants to be pregnant and does so easily, is a successful artist working in a home studio, does no prenatal screening, eats healthily and exercises moderately and regularly, and plans a home birth with the support of her partner, that she is going to have a wonderful labour and birth.” This hypothetical woman would have a strong sense of self, a willingness to make choices outside the societal norms, and would make the job of the doula and midwife look easy.

How do we help the woman who is over 35, perhaps embarking on this pregnancy on her own, or becomes pregnant shortly after entering a new relationship, or is finally pregnant after enduring years of fertility treatments? What if the woman has been subjected to emotional or physical abuse in her life, has been marginalized in her life or job, or is still struggling to define her boundaries?

In the North American society of 2006, the nine months of pregnancy seem far too short to deal with all these issues. The woman often spends her pregnancy on an external journey of moving house or renovating, buying a new car, buying baby gear, fighting for maternity benefits, choosing and attending the right classes (prenatal, fitness, yoga, etc.), and preparing to entertain any number of visiting family during the postpartum period. Society places little priority on the inner journey of pregnancy.

Where is there time for introspection? Where is there time for long walks on the beach with wise women or a supportive partner? Where is there time to read novels that quietly address the emotional issues at hand? Where is there time to dance, to sing, to draw, to express the inner journey?

Perhaps the best preparation for birth is to use the nine months of pregnancy wisely. Relish this period, which bridges the gap between two dramatic stages in a woman’s life. Both literally and figuratively, take time to follow eastern philosophy and “breathe for the hollow organ.” Breathe in deeply, wait, be still, exhale, then wait for the body to take the next breath. Live in the moment. Listen to your body and get out of the fast lane of the 21st century.

This inner journey of pregnancy can be profound. If a woman listens to her inner wisdom, surrounds herself with strong women and men who will support her choices, honours her body’s need for stillness, and sees time as her ally, she may yet have the birth that she wishes. It can also change her entire outlook on life. And, ultimately, it can give her the confidence to raise children with grace, laughter and understanding.

“Come out of the circle of time/And into the circle of love” - Rumi

In the past, it was the partner’s job, as coach, to time each contraction with a stopwatch. I still have my old list of “...8:27...8:39...8:45...8:54...”from my first labour in 1983. The fixation on time has continued. Now there’s even a program that you can download to your Blackberry which will graph your contractions!

In contrast, I encourage my clients to let go of actively timing contractions at the beginning of the labour process. I think timing contractions is almost too simplistic a gauge of how labour is progressing. It makes you focus on an external reality and lose touch with your inner rhythm, your inner knowledge. It can also make you fixate on how long things have been continuing which, in turn, can lead to frustration or impatience.

Take me for example. There I was, waiting for my first labour to start. I was 10 days overdue. On paper, it looked like I had been in labour for a week. Contractions were every three minutes - sixty seconds long. I thought I was going through the longest labour on record. But I was still able to walk and talk through each “contraction.” I was really just having prelabour tightenings. But my fixation on timing had made me exhausted and mentally drained even before the true labour began. If I’d been able to talk with someone a few times a day during that last week, someone who understood the logic of the body and the rhythm of labour, I might have been able to rest more, and been more emotionally capable during the true labour.

Now, when I’m working as a doula, I try to help people deny the niggly prelabour stuff. If you think of the early symptoms like the start of a period then you may be able dismiss the first signs of labour (the “forget it” stage). Sure, we talk on the phone during this period, but you certainly don’t need to time anything. If you only attend to the active part of labour, where you can no longer deny it, it will feel like your labour is shorter. (Like a client this year who denied things so beautifully throughout the day that she asked me, "Do you really think I'm in labour?" when I arrived at her house. It was only 5 hours later that her first baby was born.)

Now, I watch the momentum of labour, the woman’s movement, her face. Is she flushed? Are her knees bent? Is she rising onto her tiptoes at the peak of a contraction? How much clothing can she stand to wear? What sounds is she making? All these things tell me how her labour is progressing. But I’m not the “keeper of the wisdom.” In prenatal visits, I share all these secrets with clients.

I just love it when I get a phone call from a dad..."Uh, she’s doing that thing you showed us on the chair. The contractions only started half an hour ago, but I think we should just meet you at the hospital." I can hear her low moans in the background. It’s so great to know that he “gets it,” and hasn’t had to rely on timing contractions to determine the fast progress of her labour.

If you truly MUST write down the contractions (for the baby book), do it. It can be a fun way to keep busy during early labour. But it’s only good at showing you exactly when active labour starts. When does that happen? Well, the moment a woman says, “Put that pen down and rub my back!” she has reached the start of active labour. Oh, and another great indicator of the beginning of active labour is to play a game of cards. I was at the hospital with a woman who was being induced. “When will I know that it’s REAL?” she asked. “Well, when you throw your cards at me,” I said. It was only another half hour later that she threw the cards down. “Now, I know what you mean,” she laughed, as she jumped out of the bed. Ahaa! She had entered active labour.

So, here’s a great way to access your instinctive side: Take off your watch, turn all the clocks around... and feel the rhythm of contractions. For example, you can lean on the kitchen counter for a contraction, then pick a walking circuit around the house. You might have to walk three circuits before another contraction comes. After an hour, you may only be able to complete two circuits before the contraction comes again. You will know “in your body” the rhythm of labour, and won’t need to focus on time any more. Once you are able to flow with the labour, this will encourage a trancelike state (ah, endorphin release!), and help you go deeper into labour. But, always remember to keep in touch with me and your midwife or doctor. Oh, and we’ll know that it’s time to go to the hospital when you can’t walk another circuit (I will certainly be with you by that time!)

Every labour is totally different. Some women follow the textbook and have contractions which increase in length, strength and frequency. Other women can have contractions which are fast and furious from the first contraction. On rare occasions, some women find that their contractions are “pokey” all the way through. Labour is not a linear process; it ebbs and flows as the body and your baby requires. I will help you navigate this rhythm. When I talk to you on the phone, I will be thinking about how many times you have to stop talking (i.e. have a contraction) within a 10-minute period. In early labour there might only be one contraction every 10 minutes. Generally, in active labour, 3-4 contractions will occur in each 10 minute period. But the sooner you can let go of time, let go of your “thinking brain,” the sooner you will experience the timeless rhythm of labour. You will be able to cope much better.

So, I encourage you to trust your body’s rhythm, drawing guidance from your chosen caregivers. Talk to your doctor or midwife in advance about phone contact in early labour. Remember, you’ll be talking with me on the phone A LOT in early labour, and I will come whenever you need me. My arrival isn’t based on time, but on your need for extra support. Or your partner’s need for support! Then...I’ll be there.

Mail sampler (to encourage new mums)

Dear Jacquie,

Sam is 10 months old now, and doing really, really well. She is a very mellow, happy baby (and she sleeps through the night which makes life SO MUCH EASIER).

My birth experience has stayed close to me through everything - to be expected, I suppose, but it has become a memory that I draw on when I'm having one of those tough days (i.e. not enough sleep, Sam teething, Sam not eating her peas, all of the above in combo with PMS - I *so* didn't miss my menstrual cycle...). My memories are overwhelmingly positive, and much of that has to do with your calm presence throughout. You set the tone, you guided me to that place where I knew that my body would - and could - do what needed to be done. That strength and confidence has made all the difference, particularly during the early months when everyone around me seemed to think they knew what Sam needed better than I did; whenever I've had doubts, I've gone back to that basic trust in my body, and it has so far given me the best advice.

My trust in my intuition, and in my body's ability to take care of itself and my babe, is at the very core of my mothering. I think that your guidance through the birth helped me find that - and for that I thank you. I hope you're available when we do this again! I'm really looking forward to it. How weird is that? I must be ovulating... ;-)

I hope all is well with you and yours!

Maureen

Intuition, Trust and Red Flags

It’s funny how, over the years, I’ve only been given the births that I can handle. Each birth prepares me for the challenges of the next. What amazing gifts these women give to each other.

When I began my life as a doula, I was still breastfeeding my one-year-old son. I knew that I could only manage six hours away from him. For me - I couldn’t stand the breastmilk backlog! For him - hey, he needed me. For the first year, the births were amazing. I was never needed for more than six hours. I was only faced with long births once my son was able to go longer between feeds. Though I do remember pumping midway through long births for a few years...

Each birth has taught me an amazing lesson. For example - the very first birth I attended as a solo doula was a 4 hour vaginal breech birth. Being a new doula, I was nervous about the possible challenges with this birth - I’d read my medical text books! But my client was unperturbed - she had been born breech herself. So, when she went into labour and her husband was nowhere to be found, she called to say we should meet at the hospital, then called her doctor and asked him to pick her up on the way. Then she actually made the doctor take her through McDonald’s drive-thru so she could pick up a Big Mac! “Why not!” he said. Well, that baby came so easily and swiftly. “It wasn’t as bad as a rowing workout!” said my client after that baby was born. Wow! That was my first lesson in trusting the client.

At that point, I realized that our internal knowledge is strong. My client’s birth had gone smoothly because she wasn’t concerned for her or her baby’s safety. She wasn’t being irresponsible or foolhardy either. She just totally trusted her body to work well. I believe she would have had a sense if something was wrong - and would have acted on it. That’s just the way things work. Problems only arise if the woman’s intuitive sense is blocked, or if she is forced to second-guess herself. That results in fear, which further complicates matters. But those are things that we discover during our prenatal visits.

You might argue that we can never anticipate when a medical emergency is going to happen - that some emergencies come out of the blue. Well, yes, sometimes the course of a labour can change in a moment. But it is never without warning signs. The problem is, women’s intuition is not being honoured, and caregivers aren’t continuously with the woman, and miss the warning signs. As an experienced doula, sometimes I’m the only person who is consistently there, knowledgeable enough and detached enough to see these warning signs.

I was with a woman in labour at St Pauls. On paper, things appeared to be going well. She was at 5cm, unmedicated, had intact membranes, and was rocking back and forth on her hands and knees. But she was worried. She kept having images of the baby pushing his head out of the pelvis. The staff were busy with the shift change, laughing and joking. The new doctor on shift, who I know well, asked if I had any concerns. I went into the hall with her, and told her about the woman’s image of the baby. I also told her that I had a very strong intuitive sense that something was wrong. I “felt” a bad odour coming from the woman. The smell was so subtle, but ominous. The doctor went back into the room and couldn’t smell anything odd. I said I just knew that something was different, that I couldn’t shake the bad feeling that I had. The doctor stayed in the room for the next hour, monitoring the woman’s contraction pattern by using her hands, listening carefully to the baby’s heartrate. After an hour of seeing the baby’s heartrate climb, she asked the labouring woman what she thought - intuitively. The woman looked at her doctor - “Intuitively? I think I need a cesarean. But that’s crazy, isn’t it?”

“No, we’ll do it,” said the doctor, “I trust women’s intuition.” And, yes, you guessed it - the smell in the OR was terrible. My client had a massive uterine infection. I was right, I had smelled the change in her body. And the woman’s sense that the baby didn’t want to come vaginally, that he was pushing away from something, was correct. The mum and baby did very well after the surgery, but it had been a close call.

Babies are great with red flags. They madly wave those red flags. Our problem is that we often don’t recognize what the baby is doing. When we trust our instincts, and listen carefully to what a labouring woman is saying, we can learn so much more than is available to us through vaginal examinations or heartrate monitoring.

Think about how often the baby’s heartrate must dip during pregnancy. If mum lies in such a way that the baby’s umbilical cord is compressed, the baby kicks up a storm, mum rolls over, all is well. If mum is sitting in a deep sofa, which the baby finds uncomfortable, she’s forced to stand up and stretch. During pregnancy, we hardly realize all the things that we do in a day in response to the baby’s needs. We dance with our baby throughout pregnancy, an ongoing interplay. We keep our baby safe.

One woman in labour kept saying that she had an image of a rock climber, with the ropes wrapped around his chest, one hand on the taut rope on the rock wall. Her husband laughed and said, “You’re remembering our first date!” “No, it’s an insistent current image,” she said. She reached full dilation and started to push. Every time she pushed, the baby’s heartrate dipped (sometimes that’s an encouraging sign, sometimes it’s not...) Well, after three hours, the baby hadn’t descended at all. In fact, the baby had popped out of the pelvis. The obstetrician said his classic line. “That baby’s not even in Vancouver! He’s so high, he’s in New Westminster!” My client talked about her image of the rock climber again, and agreed to a cesarean birth.

Well, guess where the umbilical cord was? Wrapped around his chest like a rock climber. And he had his right hand clutched onto the taut cord, just like his dad had done on the first date. The couple laughed and laughed, feeling great about their decision. “I’ll trust you next time,” said the dad.

I’m so thankful for the lessons I have been taught by my clients and their babies. I have so many examples of how trusting a woman’s inner knowledge, trusting the baby’s red flags, and being continuously present, can positively affect the outcome of a labour. Women are empowered when their inner knowledge is honoured. It makes them more confident and results in joyful parenting.

But I’ll dole out the stories slowly. It’s time to call a new mum and have her teach me some more...

- Jacquie Munro, Vancouver Doula