Doula as "Obstetric Technique"

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

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

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

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

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

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

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

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

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

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

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

Le Premier Cri

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

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

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

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

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

Snapshots of Love

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

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

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

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

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

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

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

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

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

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

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

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

The Baby is Breastfeeding - Not the Mother

Hot off the press! In the March 2008 issue of Birth, check out the article "The Baby is Breastfeeding - Not the Mother" by Dr. Lennart Righard. The ending sums it up:

"In natural birth the woman is moving around in upright positions trying to find the most comfortable position and turning to herself to find her own inner strength. Such a woman is not so easy to control! She follows her own impulses and intuitions and her own body’s signals. She relies on nature. The same is valid for breastfeeding. The mother does not know how much her baby is eating, she has to rely on nature. This is the secret of success in the triad of reproduction (coitus, giving birth, and feeding from the breast): rely on nature, relax and let go, and you will be amply rewarded."

Then, take some time to view the WHO/UNICEF Breast Crawl video. Perhaps we all need reminding that instincts work! - Jacquie Munro, Vancouver Doula

Breastfeeding Tips for Dads

As part of their Breastfeeding Counsellor's course, Sarah Munro and Ann Marcoux created a podcast of breastfeeding tips and tricks for men. They interviewed three local dads and let them do the talking. So, click and listen to Breastfeeding Tips for Dads.

And...

Geared to all dads, whether they're at home or not, Man in the Moon dad and baby groups in Vancouver offer support and fun with books for dads and their babies on evenings and weekends. Offered at most Vancouver libraries, these groups start their next session mid-January 2008. Check your local library for details.

...she jumped up and grabbed onto the edge of the note.

Singing in labour is sacred. In the middle of a contraction, without warning, the note rises out of the woman. She sings to the baby, to herself, to all women. Her song can connect her to both the earth and the sky.

This past week, without planning, each woman has found her voice in labour, grabbed onto the edge of a note, and used it to take her through to the end of the contraction.

On Monday...we might not have heard her sing aloud in labour, but my first client this week drew power from the Dixie Chicks and others, by candlelight...

Then, on Wednesday, came Hushabye Mountain... "The winds of night so softly are sighing/soon they will fly your troubles to sea." She was in the shower, and the pure notes merged with the sound of the water. A nurse walked into the darkened room where I was sitting, and she stopped, stood still, and listened....then walked away. The tune found a reprise when she was pushing.

On Saturday, a woman hummed a secret tune while in the birthing pool...then continued to tone "aaahhh...oohhhh..." while waiting for her long wanted baby.

Then, on Sunday, the humming and toning and singing grew until it became an amazing birth roar. The power of the roar helped her to soar crazily to the peak of transition, then shift into the bearing down. No longer confused, she grabbed onto that low note and dug deep into the earth to birth her baby. She laughed.

The women this week make me think of the other voices that I have heard in labour...and one in particular which remains sacred in my memory. Listen to Seemi sing the Suras. See her as I remember her, a sacred voice at home in the shower, in labour...the room steamy...me, a guardian, lying on the carpeted floor, drifting in and out of sleep.

Thank you to the women in labour who sing... - Jacquie Munro, Vancouver Doula

Birth with Joy

I always say that the decor doesn't matter during birth. What matters is that you are surrounded by loving people who will stand back while you birth, trusting you to labour in your own way, in your own time, without interference. Then, you can birth with joy.

Take a look at two births from "Future Midwife." They show the potential joy in birth.

Go to Youtube and search for "Birth 8" to view a one-minute joyful birth from France, and "Birth 6" to view an untouched twin birth at the same hospital.

I wonder if haptonomy has anything to do with what is happening in these clips? Okay, ready, set...research!

Note: You might have to affirm that you are old enough to watch (i.e. log in or register), but it's worth it! - Jacquie Munro, Vancouver Doula

International Women's Day

Go to the International Museum of Women and experience The Motherhood Project, dedicated to the "sometimes joyous, sometimes mysterious, and sometimes complicated realities of modern motherhood."

Spread Passion - Watch TED

My clients often ask what they can do to prepare for parenthood. My favourite suggestion is to take time each day for a walk in the woods, or on the beach. It forces us to slow down, and appreciate life just a little bit more.

Once you have a newborn, time slows right down. You can sit and look at each other for hours, and wonder where the day went. You watch the baby scan the edges of your face, fascinated by the interplay of light and dark...

Once you have a toddler, you share the passions of childhood, the multitude of experiences in a single step, the joys of a pile of leaves or a puddle...

Then, as the children grow, parents can get lost in the day-to-day schedule, and discover that, somewhere along the way, those feelings of awe and passion have slipped through their fingers. But...

I've found a place where you can reconnect with people who have retained their passion for life - in many diverse disciplines and areas of study, exploration, business and research. Each speaker can spur a day's conversation, and make you feel recharged. So, check out the TED talks.

Watch it - don't go overboard - it's like finding a link to all the best people that Peter Gzowski ever interviewed on his Morningside show on the CBC!

As a starting point...check out Carl Honore (Feb. 28, 2007) talking about slowing down, and Sir Ken Robinson (June 27, 2006) talking about creativity. The talks are powerful and life-affirming...especially if you view a talk together, then head out for a walk on the beach with your partner. Just the right sort of preparation for parenthood! - Jacquie Munro, Vancouver Doula

Helping mothers open the door to life

Journalism students at Langara College produced eight weekly issues of The Voice newspaper. As a final test of endurance the pressure was ramped up and in the ninth week they produced four daily newspapers. Adam Johnson's submission made the top story in "The Best of the Dailies!"


“A 65-year-old midwife held my foot and she didn't move. Then she would look up and she'd smile. And I thought, obviously things are okay.”

“I just said, I need to do this.”

The deep kindness in her eyes grows determined as Jacquie Munro, 45, describes the day she found her calling. She was inspired by her second birth to share this positive experience with others. That was 18 years ago.

“It altered who I was radically,” she says. “I wanted to change people's lives the way they had changed mine.”

She began working as a childbirth educator, but when her students kept having difficult births, she decided to guide the next batch through the process first-hand. Eventually, it became a fulltime job. While she initially called herself labour support, the word Doula came into use in the early 1990s.

Doula is a traditional Greek word referring to an experienced woman who helps other women through childbirth. In its modern connotation, it is someone who counsels the mother before, during, and after childbirth, without actually birthing, or “catching” the child.

It is a job of simple acts, small gestures, and one hell of a lot of work. “It's often just eyes and hands—and just one word,” she says. “I just say, you are safe.”

On her kitchen table, Munro looks over a huge stack of file folders, each representing one of the 602 lives she has helped into the world. “God, I've been doing this a long time,” she says, smiling at the size of the stack.

She says the most important thing she does is provide continuity of care, by being there for the mother during the entire birthing process.

She says this continuity is sorely lacking in the current health care system, where mothers often deal with overworked health care workers.

Munro acts as an intermediary between the mother and the health care system, arranging the trip to the hospital, consulting with doctors and nurses, and maintaining a safe atmosphere for the mother.

“In births where there isn't anyone looking over the mother, a woman's autonomy can be lost completely,” she says. “You become a patient, which is usually very submissive.”

Munro seeks to create an atmosphere and mindset where a mother can get into the “birth trance,” a state of surrender and acceptance that allows the childbirth to proceed naturally. “It's completely analogous to lovemaking,” she says.“You cannot surrender to the process unless you are safe.”

But Munro insists the labour stage is the least of her concerns, pointing to staffing shortages at hospitals and the limited availability of rooms and medication. She is also concerned with the recent trend towards cesarean sections in place of natural childbirth because of the serious health risks associated with this procedure.

However, when necessary she uses all the tools of modern-day childbirth. “Labour pushes you to the very edge of what you think you can do, but it shouldn't be torture.”

After hundreds of births, Munro still finds profound meaning in the experience.

“When I'm in there with people in birth, it's like the door between life and death is wide open,” she says.

Munro presents a happy and vibrant personality, and demonstrates the limitless patience of someone who spends days massaging backs and easing nerves.

But there is a deep, underlying fatigue associated with work that requires such an emotional commitment.

“Last week I did three births in two days. I had four hours sleep in 64 hours,” she says, smiling. “But it's great.”

by Adam Johnson
Langara Journalism Student (Certificate Program)

The Doula Solution

Here's an article from the Winter 2001 issue of
Western Living Magazine about my doula service:

When the contractions begin and even Dad starts screaming for drugs, a little backup is a good thing.

Six hours into labour, Dad's feeling like a third wheel at the bedside. He wants to help, but he's not sure how.

"What does it feel like?" he asks his wife.

"Sour!" she hisses.

Sour? He has no idea what that means.

"It could be lactic acid she's tasting," explains the ultra-calm woman who has been massaging his wife's feet for the past three hours. "The uterus is a muscle and it's working hard. This is perfectly normal." It occurs to this man that a stranger is sharing the couple's most intimate moment. And damn, but he's glad she is.

She's a doula. "I'm labour support," says the veteran Vancouver doula Jacquie Munro, 'although when I tell people that, they think I work in union administration."

"Certified doula" is a job title that would scarcely have been imaginable earlier in history, or in a less driven culture. (Extended family or a community elder would have helped a mother through her delivery.) But somehow it's fitting that, in the age of the private trainer, more couples are embracing the idea of a personal birthing aide.

A doula is not a midwife, she isn't licensed to intervene medically; she has no particular agenda with respect to drugs or childbirth methodology. You might think of her job as simply full-service care from the ribs up (foot massages notwithstanding). Whatever needs doing - from decoding physician jargon to wrangling agitated relatives or zipping home to feed the cat - the doula just handles it. "I'm kind of the little guardian angel who just makes sure that everything is running smoothly," says Munro, a former graduate student of developmental psychology who also taught the first course at Douglas College's doula program. "I'm also the walking encyclopedia. I don't tell people what to do, but I do give them the tools to help them make informed decisions."

You're not alone if you've never heard of doulas. The term was only coined in the early 90's and derives from a Greek word that means an experienced woman caregiver of another woman. "I think they found out, actually, that it almost means slave," says Munro. "Historically, that's who was looking after other women in labour."

Munro noticed a spike in demand for doulas around five years ago as word spread, via the prenatal-class telegraph, about this option that radically reduced stress and the chance of knifework in the delivery room. There are 475 Canadians registered with the 2,500-member strong Doulas of North America Association (DONA). but since registration isn't obligatory, the actual number of doulas working in cities across Canada is unknown.

Because the doula business is, well, in its infancy, a certain amount of confusion surrounds it. For one thing, the term is understood to mean different things in different places. In New York, where hiring a doula has become de rigueur among turbo-professionals, the doula isn't present at the birth; she's sold more as a housekeeper. "Some doulas literally move in the day you get back from the hospital," explains Vancouverite Sara Dubois Phillips.

Dubois Phillips's husband hired a doula for her as a surprise gift when she was pregnant in Manhattan - though the arrangement proved a bit claustrophobic. Still, says Dubois Phillips, there were initial benefits: "She could tell me how other women had handled what I was going through, because at that time none of my friends had kids. That's why doulas are such a phenomenon in a place like New York, where everyone is a transplant."

The doula is a support system for both partners, but dads seem to benefit most - especially in late-stage labour. When he needs sleep, she spells him off on the back massage. If he starts to flip out, she quietly, constantly, feeds into his ear what guys crave most: data.

"My job is to make him look so good - without being condescending," says Munro. "I try to ensure that he's directly in her line of vision, so that whenever she opens her eyes, he's there. I'm putting the drinks in his hand. I'm handing him the cold cloth. And all she knows is, He's incredible." - Bruce Grierson

CBC Radio is back!

What’s the connection to this blog? To birthing and mothering? Well, CBC Radio has been the backdrop to my life. It formed the beautiful predictable ritualistic structure for my mothering at home.

CBC Radio 1 has brought form to my life, acting as “comfort food for the mind” when I was a child, bringing sanity to my early years as a new mother, and helping me to parent young adults consciously and conscientiously. So, rather than encouraging new parents to seek out parenting information from "The Baby Whisperer" or other books that address structure and scheduling, I just encourage new mums to stave off loneliness, provide intellectual stimulation AND provide structure by simply turning on the radio.

“As it Happens” meant that it was dinner time when I was a child. “Morningside” with Peter Gzowski brought structure to my mornings when my own children were small. The sound of the beeps which signal 10am meant that I should put the kettle on for a relaxing cup of tea. The noon news reminded me to put aside the playdough and make lunch for us all. The Wednesday morning political panel of Stephen Lewis, Eric Kierans and Dalton Camp was always on the radio in the car as I drove to my midwife appointment during my second pregnancy. Once my children became readers, I would wait, pen in hand, to listen to Michele Landsberg's (incidentally, Stephen Lewis' wife) book recommendations. And in more recent years, some of my clients at home or hospital have turned on CBC Radio 1 to bring some predictable structure to their labour. One woman deep in labour told all the staff to be quiet at noon on a Sunday, just so that she could listen to Stuart McLean tell the Christmas Turkey story on “The Vinyl Cafe,” in between contractions.

Research has shown that one of the best predictors of superior brain growth and development in children is the amount that a parent talks to a baby during the first year. I didn’t read, sing, and chatter to my children to “make” them into something, but to honour them as the complete little people that they were. So, I’d be working in the kitchen, listening to a radio documentary, and asking my three month old daughter what her opinion was. In the early 1980’s I remember talking to her about a newly discovered disease called AIDS and whether the Russians invasion into Afghanistan would precipitate a global war. I remember feeling so strongly that I was helping my children to grow up as critical thinkers - even at such a young age. And they would look at me with such knowing looks, like all of this wasn’t news to them...

I also remember cuddling up in afternoons, listening to the presentation of the Classical Kids Series of radio plays, like Beethoven Lives Upstairs and Mozart’s Magic Fantasy. I knew I was encouraging my children’s imaginations. In a world increasingly full of speeding images on TV, and the manic fever pitch of video games, I could provide my children with the gift of visual images that can never be duplicated. I knew that each child curled around me was seeing a totally different scene. Perhaps that led to their love of theatre, personal expression, and intellectual bravery.

So, it was with great anticipation that I turned on the radio early this week, waiting for live radio once again. I was looking forward to a new season of “As it Happens” and “Sounds Like Canada”. I was looking forward to listening to the CBC overnight service (a doula’s life involves a lot of driving at 2am). And what was the first thing I heard when I turned on CBC Radio 1 for the first time in months? An advertisement for Stephen Lewis’ October 18th "Race Against Time" Massey lecture at the Chan Centre. I must go listen to him - and take my family.

Things haven’t changed a bit.