Birthing from Above

From the desk of Jacquie's daughter

Growing up surrounded by my mum's work in childbirth, I had a slightly different introduction to the subject of reproduction than most children. Instead of reading "Where Did I Come From?" I looked through a plethora of illustrated Sheila Kitzinger and midwifery texts. I thought it was fascinating that the egg that was fertilized to make me was in my mum's ovaries when she was born, and was thus formed inside my grandmother! Wild. When she taught prenatal classes, I would come along and play with the infant-sized dolls in her teaching materials, using the plastic pelvis as a cradle. Then, as she began to do more labour support, I would act as her secretary and run into the kitchen to intercept calls before anyone else, often to hear a flustered dad drop the phone, with his wife moaning in the background -- "Mum, it's for you."

It was only a matter of time before I felt the need to leave my role as an earnest spectator and take part in my mum's work. On New Year's Eve, 2006 -- just a few months ago -- I shadowed mum at my first birth as an apprentice doula. It brought to life everything that I had merely heard about for twenty-three years. This sealed the deal. I was sucked in and needed to learn everything I possibly could about childbirth. Or, more precisely, I needed to fill in the gaps of all the knowledge my mum had slyly been teaching me over the years. Little did I know that in giving me those midwifery texts, taking me to classes, and leaving me to chat with clients, she had been training me to one day work with her. Cheeky monkey.

So, with the advent of 2007, I began the final semester of my Master's degree in Literature at UBC and decided that I would complete my university career with a directed reading in the language of childbirth guides -- to both fill in the blanks and end my degree with a fun project. I received such a fantastic education from my mum growing up. She had given me all the right materials to read, but I wondered, what were other women reading? My guess was that most women don't pick up "Ina May Gaskin's Guide to Childbirth" during their summer breaks or watch "Homebirths in Holland" on Friday nights. I turned to popular pregnancy guides, the sort of books that you find on the shelves at Chapters or are lent by a friend. I pulled together a list of about 20 bestsellers, narrowed my focus to the hot topic of caesarean birth, and began reading with some questions in mind:

What sort of language do these books employ? What themes, messages, social beliefs, and institutions do the discourses in these books support? Are women reading from the perspective I was raised, that childbirth can be sacred, empowering, and, above all, normal? With caesarean rates reaching over 30% in parts of Canada, what are popular pregnancy guides saying about surgical births?

I won't give away my entire paper (please email my mum if you want a pdf copy,) but one conclusion I did reach after reading these popular books was that, on the whole, authors don't view birth as normal. They describe caesarean births as a medical solution to "pathological" pregnancy.

My first reaction was to get completely wound up and militant: "We've got to do something about this, mum! Our culture no longer cares about the natural processes of the body. We've turned into a fast food society that wants its babies to be 'delivered' from above. Yet all over the world women have babies at home with midwives, without medical interventions, and their births are statistically safer!"

Then I realized that there was a simple way to counter the line of thinking present in pregnancy guides. Use language as a tool to reclaim birth from degrading discourses. That's why I like the term "caesarean birth," as opposed to caesarean section, c-section, c-sec, or C, or capitalizing Caesarean. By changing the language we use, we change our mindset.

I've known my whole life that birth in hospitals or through surgery has the potential to be sacred and empowering. Mum helps make that possible with the language she uses -- clients reading this know what I mean. She translates medical terminology into something a woman and her body can understand. Using positive phrases and non-judging words, she attempts to take the fear out of birth and make it normal, relatable, possible.

Why can't pregnancy guides do this? Because in our North American culture, birth isn't normal, relatable, possible. And that's a load of bunk. Don't read them, just use them as doorstops (except those by Kitzinger, Gaskin, Gurmukh, and the Dr. Sears family -- they're a'ight). Just read books during pregnancy that shut off your thinking brain and allow you to listen to the rhythms and instincts of your body. Children's books and trashy romances work well.

Oh, and hire my mum.

And just wait until our book comes out!

- Sarah Munro

Harper's Arrival

Today I drove a couple to the hospital.
I ran out of their building, jumped into my car, did a U-turn,
saw her kneeling on the stairs as if in deep prayer
her husband's body draped over her in protection.

Watch the bumps
30 minutes of head in the pillow
head on his lap
loving words
low moaning
legs braced for the curves in the road.

Water - I need water.
You're doing it.
You're amazing.

He calls out our progress
We're at Boundary
We've passed Knight Street
We're almost at Cambie
We're on Oak.

Press the button to obtain a ticket.

We park
One contraction
Two contractions
Back out of the car

Fully dilated

"The Assumption of the Virgin"

Birth and death are inextricably linked.

Though Mary, after death, is spiraling upwards into the divine light, there is such a feeling of joy and birth in this painting.

When I was in labour with my son, there was a moment when I felt the door between life and death was wide open. It was such an indescribably beautiful feeling.

Four years later, when I asked my son where we go after we die, he answered, "Silly, just where I came from!"

In memory of the students at Virginia Tech...

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."

"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

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

Land Speed Records (baby style)

The three little girls born this week almost set land speed records. The total official labour time for all three was 5.5 hours. Wow! (One was a first birth!) Now, I'm counting the official labour time as starting once TWO progressive regular contractions are coming every 10 minutes. (That's 2/10 for short.) Now, the total time of the three labours from the "first sign" adds up to 14 hours.

So, we had "fair warning" for each. I made it to each birth...and we all made it to the hospital in time (my apologies to the drivers that we flashed on the highway!) We didn't spend much time at the hospital before each baby was born (45min, 2 hrs, 30 min.) And...the quotes from the mums and dads and babies were great... "It's amazing the second time around - that was a little easier!" "I can't believe it's over already!" "The whole thing was incredible - crazy!" "That wasn't as bad as I expected!" "Whaaa!"

Now, I wonder if these girls flew into the world because they knew they were joining their sisters? Between these three families, there are now 6 girls!

Welcome to Hannah, Sadie, and Ava! - 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

It’s raining baby girls...and a boy!

Six little girls and one little boy in ten days...

It all started with a funny phone call which woke me up... “Hey, Jacquie, it’s Mel! I’m at the hospital!”

“Mel?” (I have a Mel who's due in a month...) Wake up, Jacquie...This is another Mel...She’s friends with another client, and must have driven her to hospital. “Right! How is she? What’s happening?”

So began the 10 days of fun (no overlaps.)

Girl’s night at St. Paul’s. Eight women waiting for a baby girl. Magic, laughter, acceptance, hugs, and love...and a “face-off with a skunk” thrown in for a bit of drama. My daughter was there, too, to witness this birth, to add a greater measure of awe to the night. Hip shakes...”I want to rock!” “I want to push!” ...then, “Hi, Sugar!” “You smell like graham crackers.” “You’re beautiful!” This was a birth of simplicity and joy. It was such a gift to be a witness on this night...

Then, another girls night...but this was a challenging lesson of acceptance and love for an unborn baby. The water breaks before its time, the baby finds stress in labour, decisions need to be made, plans need reviewing...and a tiny girl is born. Deep love is borne out of adversity. Friends come out of the woodwork, and reaffirm that people can be good. So good.

The third birth started the next day...with a cough. You know, coughs really help open that cervix! Tissues placed strategically around the house...roaming through the rooms, climbing stairs, dancing, showering, telling stories of ducks and friendship, listening to the renovations in the basement. Just a normal day. Then the excitement begins...

I tell my clients that birth is not a linear process. The numbers mean nothing. You can get stuck at 9 cm for 7 hours, or you can go from 1-10 cm in an hour. What we need to watch is the rhythm, the momentum of the labour. If I’ve been with a client all day, I just KNOW by watching the labour escalate how long it will be... So, it was getting strong. We went to the hospital. “No, you’re only 1.5cm dilated. You’ll need to go home for a while.” It didn’t make any sense to me - I could feel that the baby was coming. The power of the contractions was palpable - I could almost feel the buttery quality of the cervix. She knew her baby was coming. “We’re out of here,” says dad, protectively. Back home, she spends 10 crazy minutes in the shower. Then.. “We have to go back to the hospital!” We pant together in the car, I “hear” the baby slide deeper and deeper. We arrive and roll into the birthing room - baby is born within 15 minutes. “We had a girl!!!” The nurse that asked them to leave earlier, apologizes...

Okay! So, what did we learn here? Trust the mum!

The next day, only three days before a booked cesarean...labour starts. Yahoo! What a joy! Music and showers, music and showers. And a labour that really takes off once mum kisses her son before his nap. “Love you!” calls Oscar as he slides down the stairs to his bed. A quick trip to the doctor’s office, surprising the other patients - a contraction here on the wall, another by the stairs... 3-4 cm...”Okay, okay, okay...” Then back home for pears and a lovely long bath...and sleep, and quiet calm contractions. Off to the hospital to settle in... “Ahhhh...” so quiet in the room. The water breaks, crystal clear. The room is dark. Hot blankets wrap her body...hands stroke the legs in rhythm. U2 plays “It’s a Beautiful Day.” She stands...and has her baby. “Oh, you’re going to love your brother!” “That might have been the best thing I’ve done in my life!” VBAC works!

Four stories told. Three more stories to tell. But, take time to digest how normal, logical, yet magical birth can be... before I continue...

"We go intertwined..."

Hello Jacquie,

I have been thinking about you today so I thought I would email. Today I was especially amazed by the miracle of Ethan and the amazing little person taking shape before my eyes. I was just on your website reading your wonderful writing and I realized what gratitude I feel for having had your warm presence at my labour. I will never forget the feeling of your sure hand on my foot. Just recently I find my mind wandering back to Ethan’s birth and wanting to dwell.

Well, Jacquie, I hope you are well and it amazes me that every day of your life is spent supporting, and surrounded by, the beauty of birth. You are truly blessed.

- Jolene


Thanks to Amber Hughes for this photo.

Expectation (ek'spek-ta'shn)

n.
1. a. The act of expecting. b. Eager anticipation: eyes shining with expectation.
4. Statistics b. The mean of a random variable.

Hmmm... I love the various meanings. It suits labour and birth, doesn't it? People even say, “She’s expecting...” when a woman is pregnant.

So, is expectation a positive or a negative thought process? Does it help us to realistically anticipate the event? Or can it set us up for the possibility of failure and guilt?

One thing that I discuss with clients are their anticipated “roles and expectations” - of themselves, of each other, and of their caregivers. Clients share their dreams for birth, however varied. Then we compare their expectations to the many potential realities.

One woman said her expectation was to have me provide her with a perfect birth with no pain. Another expected that she would have to fight the medical staff to have her wishes honoured, so she presented me and her doctor with a hard laminated birth plan which included her wishes for an enema, early epidural, and episiotomy. Another client expected to hear “angels singing” at her home birth.

How could I work with each woman to bridge the gap between her expectations and the potential reality while honouring previous life experiences and addressing her current needs? I had to gently help each woman to see that, while she could have some control over her environment in labour, she ultimately had to open herself up to the “wild card of labour.”

Labour is all about surrendering to the power of our own body, letting go of expectations, and accepting the “mean of the random variable.”

So, you probably want to know what happened to these three women...

The first woman also happened to be a therapist. I told her that I was uncomfortable with the pressure of her expectations. I said my role was only to support her, to help her gain the strength to make her own decisions, to have the birth that SHE was meant to have - not one that I “provided” for her. Together, we drew up a worksheet covering our expectations of each other, and our roles. We expanded the worksheet to cover all her family, friends, and caregivers. The understanding which grew out of this worksheet - which became an amazing collage-like venn diagram - led her towards a better understanding of herself, and, ultimately, a 4-hour labour which was mainly spent in her hot tub.

The second woman had suffered a life of abuse. She had also been in foster care as a child, and had never felt the power of autonomy. I told her that I would honour her wishes, and trust her to make good choices in labour. I said she might only want to make one change to the birth plan (she furrowed her brow,) and add the sentence, “It is a woman’s prerogative to change her mind.” She laughed so hard when I said that. She wrote the sentence at the bottom - in indelible ink.

On the day of labour, she was so happy and open. She knew she could trust me, and the others around her, to honour her wishes. She found that she actually enjoyed labour (it was hers and hers alone) - and decided to NOT have an enema, NOT have an epidural, and NOT have an episiotomy. She trusted her body and her own ability to make decisions - and to change her mind. She said afterwards that, because she knew she could trust us, she could let go of her expectations, and it had changed her life.

The third woman...well, I had to tell her that home birth is a testament to a woman’s trust in her body...but...

I also had to tell her that we often imagine home births to be like “A Child’s Christmas in Wales,” full of nostalgia, angels singing, flickering candles, and beautiful music. But we have to open ourselves to the possibility of it being a lot more like Christmas when you’re grown up - no Santa, no angels singing, no fuzzy nostalgia. More often than not, it’s just like real life (which is why I love home births,) complete with the noise of the garbage truck in the back lane, the phone ringing off the hook, dad running up and down stairs to get an extra heater or an extension cord, the wheeze of the hot water dispenser, and lots and lots of raucous laughter. She said that she hadn’t thought of that possibility at all, and thanked me for opening her up to another perspective. She said that she would let the day be what it was meant to be, and let go of her expectations.

...and on the day of her labour, I put the lasagna in the oven, ran upstairs to be with her as she laboured in the bath tub, walked over the crinkly-sounding plastic covering the carpet...and I heard her humming...

“Well...whaddyaknow?” I thought to myself. “The angels sang!”

Yes, what do I know?

Birth is unknowable.

It defies expectation.

- Jacquie Munro, Vancouver Doula

Walk into the cold with your scarf on

Each birth has a central memory upon which all the others cling. Last night's birth has a central memory for me which sums up the power of this amazing woman having her first baby - cold night, crunchy snow, coat on, red scarf over her head, 7cm, keys in hand, "I'm going to the car"...

Wow!

Just goes to show that you never can tell how it will all go - nine and a half pounds can be hard, but on some nights, it can just be like butter and slide easily and gently into the night.

The human body is a miraculous thing.

Room 8

Was it just this week that I attended two labours in Room 8 at BC Women’s? Was it just this week that my daughter came with me for the first time to attend a birth?

Midnight on New Year’s Eve came while we were in the assessment room, during a contraction. Nurses blew horns while my client laboured. The nurses station was laid out with food. It was surreal.

Throughout the labour, my daughter held the space like women did a long time ago - knitting, crossed-legged, low to the ground - bearing witness to this sacred event.

Eighteen hours later, after many challenges and hard decisions, Samantha was born - all 9lb6oz of her. The sound of her mother’s voice the next morning will remain in my memory - “She’s beautiful! I feel wonderful! You should see her!”

Then, the next day, another client, 4+ days after her water broke, agreed to an induction of labour. The telemetry monitor afforded her great freedom of movement - to the shower, walking, leaning, kneeling on the same mat on the floor where my daughter had been knitting - as she danced the baby through her pelvis.

After another day and a half of unflagging effort from mum, and the loving support of her midwife, nurses, doula, and partner...she decided that the obstetrician needed to help her baby find a way out. And 10lb Thomas was born...

Two bonnie babies - two cesareans. Two new mums who need to be reassured that they made the best decisions that they could on the day, that they used the tools at hand effectively and wisely, that they can still trust their bodies and their babies.

The cesarean rate at the hospital was 37% for this past month (December 2006.) Typically, my clients’ yearly cesarean rate is 10-15%. In the past month I’ve attended 6 births...1 at home (8lb), 1 quickly at hospital (7lb4oz), 1 forceps birth (9lb6oz), 3 cesarean births (8lb11oz, 9lb6oz, 10lb.) Can we draw any conclusions from these numbers? You might think so, but I really don’t know. Each labour is so different. Each baby comes out exactly the way he or she is meant to...to fit their personality and life path. We can do everything in our power to keep birth simple, calm, and wise, but ultimately, we must bow to the baby’s wisdom and honour their messages.

As parents, listening to our children and respecting their needs can never start too soon...

White Lightning at Christmas

Dear Celia –

“I am a wonderful mother!” you cried while you were in labour. I wondered why this thought surfaced in the middle of a contraction. I didn’t disagree with your statement, but these contractions were like white lightning, your labour’s power vast. This triumphant cry hung in the air...

Ah…it became clear once the rest of the statement was spoken. “ - or else I would have just booked the cesarean weeks ago!”

The tangle of grief, guilt, willpower and pain was almost palpable in this tiny room at the hospital. I was at your back, stroking, squeezing, pressing – trying to help your baby negotiate through your pelvis on this Christmas Eve, and willing your cervix to open this time. Seven years ago, it had been so similar, and your son Andrew had been finally lifted from your body after a long hard labour. And now here was a deja-vu moment - I was bringing all my knowledge, all the strength of my hands, to bear, without much effect. Your cervix was still closed, the contractions raging like you were about to give birth. Here we were, your witnesses, your helpers, at your second son’s birth. At your side was your baby’s godmother, able to lend support without even having seen a birth, keeping her jet-lagged body awake in solidarity. Your dear husband was sitting close by, his lips tight from his own back spasms. I could see his own pain rise off his body like a desert heat.

No room at the inn on this day before Christmas. Why does this always happen?

I’m sorry, Celia, that your own doctor wasn’t available. We didn’t have the bat-phone to contact him. I’m sorry that the head nurse, caught in the middle of it all with only 14 nurses on shift, couldn’t get you a room. I’m sorry that the OB Resident and anesthetist were held up in the OR, helping another woman. I’m sorry that I had to keep telling you to wait – to wait - for anything stronger than the nitrous oxide gas. But I’m glad I could be honest with you, and stay by your side.

You amaze me, Celia. When we talked on Christmas Day, one day after giving birth, you said you were thankful that you hadn’t been given the cesarean in the morning. You were thankful that we got you an epidural, gave you time to think clearly, to sift through your baby’s internal messages, your body’s strong messages, before finally having an emergency cesarean in the afternoon. You said you were thankful that you had those seven years between your children…thankful that you now finally know how hard your body was trying to tell you that something was wrong in the past few weeks, in the past years. You said you were glad to be able to understand that things really do happen for a reason, and that your questions of the past years have finally been answered.

I have always had infinite faith in women’s bodies. You have strengthened my faith.

I am so glad that I was there for you, to witness your children’s births. Because I was at Andrew’s birth, I knew how strong you were. Despite what you might jokingly say, I knew that you wouldn’t call for pain medications unless your body was telling you to “take action!” I was so glad that I had seen the precursor signs to uterine rupture before. I thank the other women I have worked with, Barb especially, who have walked through this potentially life-threatening doorway before. Barb had been so calm in the bath, at 9 centimetres, when she had said, so quietly, “Jacquie, there’s an emergency,” and I had known exactly what was happening. Even months later, she said she’d never been scared, never doubted that we would honour her body’s cues, and her inner knowing. She knew she could trust the women at the hospital to care for her, to do the surgery well, to look after her body and her baby. I am in awe of this deep trust, and so thankful that it can exist in 2006.

So, when your body found a miraculous way to make the pain break through the strong epidural, I knew that we all had to “take action” and move swiftly. Thank-you, Celia, for breathing slowly and deeply for your baby through it all, for letting go of expectations, for telling everyone exactly what you needed at each minute, for trusting that everything has a purpose, for being a wonderful mother…

Thank you to all the staff for listening. Thank you to the Obstetrician for being gentle and respectful. Thank you to the OB Resident for her elegance under pressure. Thank you to our nurse for her calmness when she could have given in to fear. Thank you to the Pediatric Resident for holding baby Callum with reverence.

Celia, you have walked through the door between life and death, as all mothers must, and come out the other side. So many women these days are fearful of the feral nature of birth and mothering. You walked through to the other side with grace, in spite of the fear and pain.

At this Christmas time, I can’t think of a more fitting birth story. It wasn’t easy or smooth; it was raw, it was real. Celia, you taught us all about the infinite strength of the body, mind, and spirit. And, yes, Celia, you must be a wonderful mother!

With love to you and your family –

Jacquie

Birth of the World

After a bout of pneumonia (of course it wasn't due to overwork...but maybe all that drywall dust had something to do with it) for most of November and early December, all's well. Five new beautiful babies are in the world, bringing joy to their families.

The first flew in 5 weeks early...so sad that I missed it while I was so sick...

The second found me doing my doula work over the phone, drugged and coughing. "She's acting like a caged animal," says dad. "She sounds wonderful," I said, "But it sounds like it's time to go to the hospital." She had spent most of the labour at home, with me talking her through the contractions, encouraging showers, recommending positions, giving pep talks to her husband, arranging their hospital arrival, and helping them to get "the good room." Phone doula work isn't ideal, but it seemed to be better than nothing that day.

The third was a triumph of spirit...and a testament to a woman's power. After falling asleep in the tub at the hospital during transition (such a gift!,) and labouring to 10cm without intervention, and pushing and pushing and pushing for hour after hour...Phoenix was born! Truly the appropriate name for him after this labour.

The fourth baby was born after the stormy night in Vancouver, her parents waking in the night to watch the flashes of light as trees fell on power lines...then the water breaking with the help of the low pressure system, and the baby following in about three hours. Welcome to Ella "Storm Force" Wallace!

The fifth baby came on a Hanukkah night, born at home into her mothers hands, watched over by her big sister, Shulamit. I left them all tucked into bed, the new baby nursing...mum reading "Green Eggs and Ham" to the girls...

As we approach Christmas Day, I'm waiting for the next birth, wrapping presents, making clam chowder for a family dinner tonight, and reflecting on what this year has brought. 2006 has been such a mix of sorrow and joy...but the joy shines bright as we end this year. The gifts of this year have been amazing.

Thanks to all!

The tip of the iceberg

A nurse asked me the other day, “Do you just meet your clients at the hospital? Do you meet with them at all during the pregnancy?”

Kat’s pregnancy and birth sprang to mind instantly. A nurse herself, she knew the superstition about nurses’ labours - “you get everything that you don’t want.” So, she knew she’d have to work hard to set up the best environment for birthing her baby without much “fuss.” So, referred by a friend, she hired me one October when she was three months pregnant. She had a lovely family doctor who specialized in maternity care, and trusted Kat’s ability to give birth. Then she signed up for prenatal classes, prenatal yoga and fitness programs. Everything was in place.

After our initial interview over tea, we phoned regularly, and I made two long visits to her home, talking with her and her husband about their personal philosophy, their challenges over the years, and their hopes for the birth. I answered all their questions from, “How will he be able to finish his thesis with a baby in the house?” to “Why does everyone say I must have an epidural?”

Throughout the pregnancy there were challenges to discuss...not big enough to call her doctor, but enough that Kat needed my support. For example, early in her pregnancy, she went to an independent lab for an ultrasound. She had been shuffled in and out within 5 minutes. “Next!” She was back in the car before she knew it...in tears. We talked on the phone after that, for at least an hour. After our talk, she decided she would only go for testing at her own hospital, where there was a greater chance of continuity and consistency of care. She was glad that she could use me as her sounding board.

In our many phone calls, we talked about her fears... “What if it’s so fast that you don’t make it to our house?” and her thoughts on her own ability to deal with pain...”I’m a bit of a wuss.” We talked about her hopes and dreams, her expectations of motherhood, and her concerns about her husband making it through the labour if it was long ("He'll need to sleep!") She called whenever she had a cold, when her friends gave birth ("Why isn't it me?"), when the baby was moving too much or too little, when she needed help sleeping, whenever anything needed to be discussed.

I worked to help her see the big picture, to help her to let go of expectations, to help her listen to her body. As an oncology nurse, she found it was a struggle to let go of fears, but, with encouragement and her own strength and wisdom, she met the challenge.

In late March, another phone call: “Did I tell you that I want to avoid the baby being suctioned, to have everyone quiet at the birth, to avoid medications, to get lots of encouragement??? The last minute worries had surfaced, the fear of not having her wishes honoured was voiced. We had talked for 12 hours by this point, over the course of the pregnancy...and it was really starting to spill out now.

Then came the due date. Another phone call. Then came another two weeks. Daily phone calls to me. More doctor visits. Testing at the hospital. Our contact increased as the days passed. When she finally went into labour, she was comfortable with her “team,” and we had discussed almost every possible scenario in advance. Kat had decided that, in order to labour with minimal intervention, she would have to stay home as long as possible.

Two days later (all the time in labour)...

...we had baked, walked, made soup, taken photos, and watched two nights of playoff hockey. Her husband was finally asleep in the bedroom, and I was at my limit and ready to fall onto the futon beside me.

Kat was still pacing the living room. To say she was frustrated was an understatement. Her contractions had never quite “kicked into gear.” We had been in touch with the doctor and hospital at regular intervals, and had been told to stay home until things escalated. What was it going to take?

Finally, I said that we would have to go to the hospital for further support if nothing had changed within the hour. I suggested that she try one last bath, (and a firm talk with the baby!) while swishing her hips from side to side to loosen her body. I closed my eyes...

“Quick! Jacquie! My water broke!” The words tumbled into my dream. It was an hour later. Kat was standing beside me, dripping... I tried to wake up. The next contraction came, and it was STRONG! Finally! I worked hard to wake up her husband, and we drove Kat to the hospital.

The baby was born!

Someone at the hospital said, “Well, that was easy for you guys! You just popped into the hospital and the baby was born!” We all yawned, then laughed.

So, to answer the nurse’s question, “No, I don’t just meet the couple at the hospital. We usually work together for many months during the pregnancy, and many hours in labour before you see us. It might look easy...but...”

It’s just the tip of the iceberg.

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!

Old and New Collide

Screeching into the 21st century, I've started listening to podcasts. My favourites so far (apart from the CBC, and BBC Comedies/Quiz Shows) are the downloads from the health segments on BBC Woman's Hour. Just the name reminds me of being a little girl, rolling out playdough, my mum listening to the radio. It's rather soothing. But the information is current, and the discussions are compelling. I always feel the need to dash home to my computer, tear off my iPod, and google away to discover more on each topic.

It's just the stimulus needed when you have a new baby in the house. Something to make you feel all "adult" again. I hope you enjoy these podcasts!

p.s. Please remember that the British Medical system is quite different from ours, with different protocols, recommendations, etc. Please listen these podcasts from a social and cultural perspective.

“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.”

Oh, Maggie!

The wind blew the clouds and rain away, giving her the sun’s heat upon her back, and showing her the first snowfall on the mountains.

We stood, with the tourists, at the Queen Elizabeth Park viewpoint. She stood, leaning over the bench, pointing out the dried candle wax, the other pregnant woman, the babies, not really looking like a woman in labour.

But she was…

Oh, Maggie! She’d been through so much pain in this pregnancy, and many labour “warm-ups” (let’s not call it false labour any more!) and she was still unconvinced that this was the real thing.

But it was…

At lunch time, she’d been feeling well enough to grab a Subway sandwich, challenging the sandwich artist over the ins and outs of the 2-for-1 deal. Now, on the hill, only an hour later, it felt like we should at least call the hospital and put them on alert.

By two o’clock, we were at the hospital – “doozies in the car.” By 2:30 she was “in the zone.” And just before three o’clock, we were upstairs by the elevators, working through another contraction.

“OOOOOOOOOOOOOO,” she called, head buried into her husband’s chest, as a little boy walked past. She must have seen his feet, because she quickly said, “OOOOOO, I’m a ghost!!” Her need to reassure the boy was stronger than the power of the enormous contraction.

Everyone in the hallway laughed! That’s Maggie – so strong, so great, so quick to lighten the mood for everyone else.

She was only in the birthing room an hour before her beautiful son came into the world.
Smiles! Such joy!

“Jacquie, that wasn’t bad!”

“Whaaa!!” says baby.

Mum and dad talk with baby…
“It’s so bright!”
“I’m glad you decided to join us!”
“Your chin is so cute!”

What a wonderful day to be born, Benjamin!

Duthies goes down a notch

Okay, I've been a Duthie Books fan all my life. It's an independent book seller in Vancouver, with well-read employees, a great book selection, etc. etc. I bought the new Zadie Smith novel, On Beauty, then headed to check out the pregnancy books, as usual. I headed to where they usually are...and stopped, mouth open... There was a massive product placement of the What to Expect When You're Expecting series (good only as doorstops), The Baby Whisperer (don't get me started!,) and The Caveman's Pregnancy Companion (Oh, dear! Do they really think men are happy to be treated like morons?) I had to walk out...

So, I popped into Chapters today to see how they were doing...and didn't find ONE What to Expect book, found a few Sheila Kitzinger books, and purchased two very obscure and interesting-looking pregnancy books (I'll let you know...) Here was a chain store with a selection that was certainly better than Duthies.

For a consistently good selection of pregnancy books, grab a chair and sit at Banyen Books on 4th Avenue. Now, if we could just get Tanglewood Books, with those wonderful creaking wooden floorboards, to stock amazing pregnancy books...then I'd be happy.

And then there were Ten

There have been 10 babies born since we returned from our summer holidays, only one of them a girl! Welcome, and congratulations to all!

Snapshots:

Kate’s birth - Nurse: “This little one is going to give us all grey hairs!” (Said on the twentieth fetal heartrate dip before gorgeous, bright-eyed Kate arrived)

Connor’s birth - Mum: “Sorry to get you guys out of bed.” (Said to Grandma and Sister, Dad and Doula, Doctor and Nurse near the end of her 3 1/2 hour labour)

Emmet’s birth - Mum: “That wasn’t bad.” (Boy, did she motor! Moved from standing, to sitting, to squatting, to shower. So, so fast!)

Lochlan’s birth - Doctor, smiling: “What is she on?” (Mum chatters away happily in shower, then stands for birth)

Liam’s birth - Nurse: “She couldn’t possibly be pushing. I just checked her and she was a fingertip dilated.” (Baby born 45 minutes later)

Cameron’s birth - Mum: “It’s just like a marathon - some good bits, some bad bits.” (Said half-way through the 7 hour labour)

Oliver’s birth - Friend, calling from downstairs: “Dinner’s ready!” (She hadn’t noticed that the baby was just about born...by the stairs)

Klein’s birth - Head Nurse: “Has your nurse done her rural Africa trick with the sheet?” (Baby eventually waved all red flags and asked for immediate exit - leading to a joyful, laughter-filled OR)

Adam’s birth - Mum: “I think today might be the day.” (Baby born 43 minutes later, unexpectedly at home)

Oscar’s birth - Mum: “I enjoyed the day. It was a good day.” (Said while nursing baby for the first time, triumphant)

We wrestle angels

On my way to see a client the other day, I drove past the beach, and watched the sailboarders fly through the October waves. Last night, the image returned as I listened to Michael Symmons Roberts on the radio, reading from his own poem about observing sailboarders:

"These men wrestle angels. Each now sits on / an enormous wing waiting for the winds to rise"

For me, it always comes back to labour. For, in labour, we wrestle angels. We struggle to blend reality with expectation. We skim the ecstatic knife edge between pleasure and pain. We emerge, changed utterly.

Thanks to Deb, Elaine, Sheena and Betty - the four midwives who helped me wrestle the angels

Searching the past for ritual

Over the years, I have been a witness to many birth rituals. Often, these are rituals drawn from different cultures. Those that spring to mind...

A Tibetan woman had a long labour, followed by a cesarean birth. Outside the operating room waited two beaming monks, their robes a bright contrast to the hospital walls. After the baby was born, the father asked that the first piece of cloth to touch the baby was a silk fuschia prayer shawl that had been blessed by the Dalai Lama. There, in the operating room, was one spark of colour. The birth shifted from medical to spiritual.

A Sikh woman laboured, standing by the bed in the hospital. While the nurse was ritually laying out the delivery cart, gloved and masked, the husband ritually laid out a prayer table. The altar of medicine looked out of place.

A Japanese woman reached down for her baby, pulled him up to her breast, and named him. "She must tell him his name as he comes to her breast," whispered her husband.

But there are also historical rituals to be considered...

At the Victoria and Albert Museum in London, a current exhibition titled, "At Home in Renaissance Italy," highlights the rhythms and rituals of Renaissance living. One highlight is a portrait of a noblewoman, wearing a marten's pelt with a jewelled head. This fashion accesory was believed to act as a guardian to women during pregnancy and childbirth. The marten was thought to conceive through the ear and give birth through the mouth. Much easier!

The women were also pampered after the birth, their food being carried to them on ritual birth trays, lavishly painted with protective images.

Pregnancy is a wonderful time to explore these cultural and historical rituals, and perhaps foster a stronger connection between peoples and times.

Groaning Cake

In our last book club meeting, we discussed The Birth House, by Ami McKay. We ate groaning cake, talked about birth, the medicalization of women's bodies at this most natural time, history, social change, and our own lives. We were strengthened by the stories of these women at the turn of the century in Canada, their sisterhood, and the quiet yet bold way in which they kept their commmunity together. I hope you read this book.

The tradition of the groaning cake at a birth is an ancient one. Wives' tales say that the scent of a groaning cake being baked in the birth house helps to ease the mother's pain. Some say if a mother breaks the eggs while she's aching, her labour won't last as long. Others say that if a family wants prosperity and fertility, the father must pass pieces of the cake to friends and family the first time the mother and baby goes to a public gathering.

2 1/2 cups flour
3 eggs
2 t. baking powder
1/2 cup oil
1 t. baking soda
1/2 cup orange juice
2 t. cinnamon
1/4 cup molasses
1/2 t. ground cloves
1 1/3 cups sugar
1 1/2 cups grated apple
1 t. almond extract

Sift dry ingredients together. Add apple. Beat eggs. Add oil, orange juice, molasses and sugar. Add to dry ingredients. Mix well. Add almond extract. Bake at 350F. for 35-40 minutes. Makes two 9x5 loaves or 18 muffins.

Boundary Bay Baby!

Perhaps the fastest baby of the year...a little boy has made his way into the world in 43 minutes!
No time for a car ride to the hospital...
No time for the doula to get there...
Just a mother and a father to receive this shining spirit...

(Well, I flew up the stairs one minute after the baby arrived, just a step behind the paramedic)

I think everyone smiled so much yesterday that we all had sore faces!

Congratulations to Sarah and Mark!
Thanks to all the paramedics and the Infant Transport Team, especially for listening to my client and giving her privacy.

That was a day filled with joy!

(2009 Update: This mum has since had another baby...this time planned at home with a midwife. Phew! An altogether more relaxed outcome.)

- Jacquie Munro, Vancouver Doula

650

I completely missed it. I passed the six hundred and fifty baby mark a while ago, but didn't stop to think about how many babies that REALLY is... Well, they're not all babies now. Many are heading off to high school or university, but close to 70 wee ones are still waiting for their first birthday.

Photos arrive as each baby reaches his or her birthdays. Christmas cards arrive showing long-limbed children I hardly recognise. But I never forget a labour. Those flashbulb moments remain strong in my memory.

I can see the woman cry out, "I can't do it any longer!" I rubbed her back, and said, "You ARE doing it!" And she replied, "No, I mean, he's passed out and I can't hold him any longer!" Her dear husband had fainted while we'd been in the middle of an earthquake, and she had been holding him and pushing at the same time.

I can see another woman roaming Queen Elizabeth Park, squatting by trees, waiting for her husband to return from his final immigration hearing. I can see him running across the park towards us, calling, "I will be Canadian!"

I see myself in the backseat of a mini, holding a labouring woman, on the hottest day of the year. Her partner is driving us through the blistering streets. We pull up alongside a throbbing car. The man calls out, "Are you all weird or are you in labour?" We all laugh.

I see another woman hold open her oven door to check on the roast beef. In between contractions, she prepares Sunday dinner. We are told we can't leave for the hospital until we have all eaten. Yorkshire pudding and gravy included. The baby arrives 15 minutes after we step into the birthing room.

I see another woman, deep in labour, smiling as her contraction ends. "I love the breaks - they're just like the best cup of tea!" Her husband flies through the door, stripping off his clothes. "I fell through the ice!" he exclaims. (Long story)

These are only five moments out of the thousands of moments remembered in six hundred and fifty amazing births. Thank you for letting me be a witness to these births, and one of the guardians of these memories.

Oliver is 22 hours old

after a powerful labour
flowed through a powerful woman -

and dinner was just ready,
a little boy in Richmond
was born in the hallway
by the stairs,
greeted by his awestruck parents

and five smiling women.

now, did everyone get their pasta?

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.

Picnic at BC Women's

I was concerned that she'd think I was crazy... "Let's meet at the hospital, on the hill across from the emergency entrance. Bring a picnic and a blanket." It just seemed the right thing to do on this beautiful day in August. How else could I create a sense of safety, close to the hospital, yet far away? High up on the hill, with lovely green grass all around, trees to lean on, a hill to climb, a place to labour without being watched.

I arrived, and there they were, looking just like a couple on the hill having their lunch. Lovely cheese, crackers, fruit, sparkling juice... A soft blanket and a lap to lean on... Contractions every five minutes. She'd rest on her side for a while, then walk for a while... We'd talk about what to expect...how second babies take their time at first, then fly out. We were in the perfect place, ready to dash inside whenever the labour became stronger.

It was so joyful to be a witness to this labour on the hillside.

"Let's go in," she said after a few hours. I had timed it so that the "fancy room" would be available, after all the new babies had been discharged, and everyone had taken their lunch breaks. We were in luck...

Sun filled room, glass tiles, the shower, a birth ball, arms to hold, primal sounds...

...and the baby came like a rocket after a whirlwind of labour. She did it! This was the healing labour that I'd wished to nurture.

The last scene...she's sitting up in bed with the take-out menus spread before her. "Which do you think? Steak? Baby-back ribs?"

This was good. Really, really good.

Into Dad's Hands

Dad caught the baby...then mum writes...

"...I haven't called as there have been no questions, no stress, no concerns. It has been unbelievable. I was prepared for chaos and tears and frustration and there hasn't been any. Just lots of quiet time getting to know one another, long walks in the neighbourhood in the early evening and tons of smiles. I still have moments where I have to pinch myself when I look at him, he just seems so unbelievably perfect to us.

I want to thank you so much for being there with us during his birth. There were many times throughout the experience when I was so relieved to have you there with us. It was an enormous comfort. You had the words I was looking to hear and I thank you for them. I was very lucky to have had my path cross with yours. I know we will have another opportunity to work with you again in the future and I look forward to it!" - Cohen's mum

Lambing time...

We're just back from the spur-of-the-moment trip to the UK, to hike, see the new lambs (saw one set of twins feeding), stand on cliff edges, and drive the one-track roads (yikes!) in Derbyshire and Yorkshire.

We also cheered as our son's band won at the World Pipe Band Championships - absolutely amazing!

Now that we're home, it seems like a wonderful dream. The phone calls have been coming in thick and fast with updates on all the most recent babies. I've been fielding questions about pooping, breastfeeding, throwing up, whether grunting is normal, how to introduce solids, parenting 2 year olds, toilet training...

I'm home for a wild week of pre and postnatal visits, then off to Hornby for our "regularly scheduled holiday."

Then the busy Fall baby season approaches. Truly lambing time...

UK Bound

Another amazing week...four babies born (stories later). Late Wednesday night, my husband paged me while I was at the hospital. I was sure he was going to tell me that another client was in labour. But he phoned to say that he'd booked seats for us to fly to England on Sunday. Wow! I picked up my passport on Thursday...attended a bliss-birth on Friday...washed and ironed on Saturday...and here we are, ready for the airport. This will be our first solo flight (aka childless) together since our children were born (23 years.) Not a bad anniversary present!

- Jacquie Munro, Vancouver Doula

Summer Heat

I've just realized that I haven't written about any of the births this month. It must be summer...

Six strong women. So many stories...

Andie's birth - Her mum was described as "enchanting in labour" by the gentle doctor. Memories of flowers, swishing water in the tub, jokes at 9cm... Such a joyful day with all the family waiting...laughter...

Weston's birth - Standing, moving, power...then those shoulders, such a challenge. Mum's grace and strength in the middle of a medical whirlwind... Finally, safety and peace.

Nicholas' birth - The granite countertop, swaying hips, fans whirring, infinite patience, acceptance... Now he sleeps and feeds and sleeps and feeds... What a journey this past year has been...

Ryan's birth - Flying car down 33rd, honking, passing... 6cm progress in 2 hours... "You know it's safe when mum and doc are comparing their toe-nail colours..."

Julia's birth - To induce: take one hot day, a boat ride, a sudden frightening squall, a car being towed... The result: A labour like a fast, stormy sea...and a baby that slides out, shimmering...

Oliver's birth last night - Sitting, standing, water, sound, stillness, movement, quiet, power...whispers of encouragement. Then, like a tribe, the women gather round, chanting "pant...little pushes...pant...pant..." "You could have had that baby in Malawi," says dad. We clean the room, turn down the lights, and slip away...

Six strong women. Two strong girls, four strong boys. What a journey awaits.

After Zoe's Birth

during the birth
my hands are the hands of all women
smoothing the lines between past
present
and future

the women are with us

after the birth
we hear the midwife
snap clean sheets
see her climb up
onto the high bed
to smooth the corners

you climb up
babe in arms
and we slip silently through the door
between life and death
to join all the mothers under the moon

One Week Old

But, despite the tears...
"Just look at her!"

"Tears and Rain"

Okay, I’m going to share some secrets about what goes on behind closed doors. Before pregnancy, no one tells women that there are going to be a lot of tears. All they see are the groups of shining skinny women pushing strollers (complete with a sleeping baby) along 4th Avenue, Starbucks cup in hand, laughing. What they don’t see is the anxiety, the tears, the loneliness, and the loss that women can experience as a result of this enormous change in their lives.

I’m glad pregnancy is nine months long. It takes that long to work through the issues that crop up...family boundaries, financial pressures, relationship issues, old wounds, loss of mobility, body image, career choices, birth worries... Women look to their baby’s birth as the end of the process, only to find out that it’s just the beginning. Then all the same issues resurface, in addition to a general sense of loss and loneliness...oh, and a crying baby.

Then I get the phone calls. Three or four women a week call me to say they are sitting in a puddle of tears, surrounded by crumpled tissues. They ask, “Is this okay? Is there anyone else feeling this way?” Oh, my goodness, yes...most everyone! The problem is that we’re all sitting in our houses, alone and apart.

Our support network of coworkers is gone (and I thought I hated to go to work!), our husbands are at work (so mad at him going to work!), the house needs cleaning (isn’t that what I’m supposed to be doing to justify staying at home?), the laundry is piling up (who knew babies could generate so much!), and people keep visiting and visiting (expecting me to make tea as they dole out their unsolicited advice.)

I’m tired and anxious just reading what I wrote!

When my daughter was born, I was fortunate enough to have a mum who lived only a block away. She would come by each morning, ironed laundry in hand, ready to clean my house, prepare the meals, and leave. I can’t believe that she didn’t say anything about what I should be doing, how I should be holding the baby, what she wanted... She would just kiss me and leave. Wow! That actually sounds like the best postpartum doula (which we all need and deserve!) But I still needed help.

Then, an amazing woman forced me to attend a mum’s postpartum support group. “It’s Wednesday at 10am...be there, clothed or not!” Once there, my daughter promptly threw up all over me. If I’d been at home, I would probably have cried over the loss of the milk that I’d worked so hard to get into her little body. But, surrounded by all the women, who were reaching out to me with towels, blankets, and tissues...I just had to laugh. That day, I sat next to the woman who would become my best friend. We have had lots of tea and tears and walks since that day almost 23 years ago.

Only yesterday, she said, “I wouldn’t have made it through these years without you. I wouldn’t have stopped in the middle of the day, and taken time for myself without your encouragement. I wouldn’t have sat down and read a book during my baby’s nap time, without you phoning me and telling me to SIT DOWN. I felt I had to account for every moment that I wasn’t out working or cleaning the house, or preparing meals for the family.”

Where did this mother-guilt come from?

Maybe I’m just a lazy thing, but I believe we need to be guilt-free about giving time to ourselves as mothers. We need to set firm boundaries with our extended families, to selfishly protect our new family of three. We need to allow ourselves to take a nap, stop for tea, read a good book, take a slow walk, buy ourselves a treat. We need to listen to our bodies and our wisdom, and honour our intellect and our intuition.

We need to ask for help from the community of women around us. We need to open our doors and gather...so we can sit in one big puddle of tears and laughter...together.

Taking Stock (or living in a bubble)

It’s good to take stock of things every once in a while. Change happens so gradually that you often don’t notice until you stand back and observe the differences. Strangers are often the first to notice changes in our children. When did my daughter change from looking like her father, to looking like me? When did my son get taller than his sister who is almost four years older than him? Somehow I missed seeing the changes in the moment.

It’s the same regarding birth practices.

When I started working as a doula, shaves and enemas were still routine. Women were given IVs, and continuous monitoring was deemed necessary. Women still had to write militant-sounding birth plans in order to achieve their goals during birth. Informed consent and family-centred maternity care was a goal, not the norm.

Now, it’s only old books on library shelves (or U.S. television?) that perpetuate the myth that these practices still exist here in Vancouver.

Maybe I live in a bubble...but things have changed here in the hospitals over the past 20 years. Monitors aren’t routinely kept in birthing rooms. I rarely see IVs given without cause or consent, and the nurse is the first person to suggest “more juice so you don’t need an IV.” No one looks at me oddly when I shake my client’s hips or help her to squat. The doctor will do everything in his or her power to prevent a woman from tearing. The nurse and I can be so in harmony that we communicate with only our hands and eyes, and guide the labouring woman into the bath. The doctors and nurses now hire me for their births. No one seems to remember how to do an enema. The dad and family are welcomed with open arms. Pretty much everything that women used to include in birth plans are now accepted as normal practice (so we just don’t write them any more). Prenatal classes include more birth art than breathing. The nurse might put aside her paperwork, take photos lying down on the floor, and cry along with the family. The labouring woman and her family are truly at the centre of this new type of care.

Long gone are the scary matrons of old. Now, I know that the charge nurse will encourage my client to stay at home as long as possible. At the hospital, she will take my client’s blood pressure twice...then wait...calm her down...three times...until she gets a low enough reading to allow admittance to “the fancy rooms.” I know that if I don’t see our nurse for a while, she’s busy trying to advocate for my client. I know that if I get a hunch that something’s not quite right, the nurse will listen to me and take immediate action. Together, we have prevented many complications.

I’m lucky that most of the doctors and midwives that I work with have recommended me to my client. I know that I can call them at any time with concerns or questions. They also call and email me an equal amount. It’s such a seamless and collaborative process that I never noticed when it reached this level of cooperation. When did we grow up?