Tuesday, May 29, 2007

A Sea of C's

For the 4th time in 3+ years, one of my clients ended up in the operating room.

I have supported clients before where I felt like they got steamrolled into a cesarean. Earlier this year I watched as a doctor (with all of his students watching) told a woman (primip, after 1 hour of pushing) that she could push some more if she wanted to, but she was going to end up in surgery so they might as well cut their losses. It was going to be a really big baby, after all.

It was 7lbs, 9 oz.

This was not like that.
This mom was an awesome laborer. She was totally able to get into the zone, that one that is so hard to describe but we all know it when we see it. She tuned out the world, tuned into her body and her baby. But in the end, her baby was in a bad position and she did not want to move. When the time came to call it quits, everyone in the room (and there were alot of us) felt good about the decision, including mom.

I cannot say enough about her midwife, Kathleen and her group, Pacific Midwifery. They are the only midwifery group completely staffed by CNMs in the area that do hospital births. And after what was no doubt an enormous amount of work, Legacy Salmon Creek is now the only facility in SW Washington doing water birth.

This, my friends, needs to be the wave of the future. Respectful, passionate, informed childbirth that takes place wherever you are comfortable. Although I believe strongly in home birth, I also feel women should be able to birth their babies in a hospital without fear. And although this birth ended in cesarean section, countless others in Kathleen's care have had normal, natural births without routine intervention. All women deserve that.

In 1965 4.5% of births were via c-section. In 2005 30.2% were. We cannot allow this trend to continue. The World Health Organization recommends a rate no higher than 15%. To find out what's being done and what you can do, visit www.motherfriendly.org

On a personal note, my wonderful doula who tended to my every need at the birth of my second daughter, is moving back east. Her compassion, support, humor and sisterhood will be missed by many, including myself. Everyone should be lucky enough to have a doula like her.

Thursday, May 24, 2007

Hold Please...

The hardest part of a doula's life is not the work. It's the waiting for the work. Not waiting to get clients (though that used to be a concern) but waiting for the clients to have their babies. When I am on call, which is probably about 75% of the year, I am constantly thinking about Plan B. Who will pick Violet up from school, do we have a spare car seat in the car, did I take a shower, who will watch the kids if my husband is at a game and cannot be reached, can I have a glass of wine tonight...you get the picture. When I am on call I plan the morning out before I go to sleep and then do it all over again in the morning when I wake up still in my bed, birth bag still in the closet.

It's very stressful.

Right now I have one client who is a week past her due date, and one due tomorrow. Tomorrow is Violet's last day of preschool, tomorrow night a wedding, Saturday a bartending shift and Sunday a barbecue? How many of these things will I miss?

Here is a perfect example: My phone just rang. Client A called, due tomorrow. Her water just broke, the midwives told her to go to sleep and wait for some contractions (I love midwives!). But...Client B called earlier, already plenty dilated, 41+ weeks, went to have an acupressure massage tonight. What happens if they both go? I have my back-up on standby, but after many months of getting to know these woman and their partners, I would feel AWFUL if I had to miss either of their births. I know it happens, but I really didn't want it to happen to me.

See what I mean? It's very stressful.

Monday, May 21, 2007

To Dream The Impossible Dream

Last night I dreamt I cursed out an anesthesiologist.

In my dream he was saying he didn't understand why any woman would want to deliver vaginally when it is sooooo much easier to have a surgical birth. I could not restrain myself, and I asked him if he ever tried to recover from abdominal surgery and breastfeed a baby. He replied with "And another thing, why would anyone breastfeed anyway. We have formula, why not use it?"

This was only a dream.

For starters, I would never have an altercation in a hospital, especially in front of a client. It's always important to maintain the birth space for a laboring mama. She needs her support people to protect her from any stress, to make her feel like the universe is aligned and that wherever she is birthing her baby is the perfect place to be. There is no room for egos in a birthing room.
In addition, one of my colleagues and I are always talking about building bridges. Even though doulas are beginning to become more and more mainstream, there are still misconceptions about us floating around the obstetrical world. Every time I interact with medical professionals I consider it an opportunity to represent not just myself, but every doula everywhere. OB's are busy people. They may not remember me personally, but I hope they will remember that respectful doula who acted with sincerity and compassion without being combative.

I am more peacenik than weathermen.

Now of course the sad reality is that there are many people floating around out there that don't see the value in the things I value most. All but one of the Portland-area hospitals sends moms home with free* formula samples. There are many doctors out there that are doing elective cesarean section, even if it goes against WHO and many other guidelines. But every time we are our there in the world, nursing our babies, talking about normal birth, we make one step forward.
We need not dream, we need do.

*Free, meaning without monetary cost, not without consequence.

Friday, May 18, 2007

Childbirth and the Magic Pebble

What is it about east-coasters that make us find one another wherever we are?

Two weeks ago I took this childbirth educator workshop up at OHSU in Portland. One of the trainers is originally from New Jersey, which is really Brooklyn only with more malls and trees. Wouldn't you know it, we hit it off right away. I ended up missing a day of the training because I was at a birth, so this trainer graciously offered to give me a private class to fill me in on all that I missed.

What I walked away from the meeting with is this: I should probably teach in a hospital.

I always envisioned myself teaching out of my house, and truthfully, I probably will. But that's not where my greatest impact can or will be. Most of the people who would take my out-of-hospital class will probably have out-of-hospital births, which means that many of the things about intervention and so on will most likely not apply. The majority of women in the united states are having their babies in hospitals. They deserve a great education by great teachers who are passionate about birth. Educators who believe in their hearts and bodies that birth is normal. Educators that know that women were designed to birth their babies and that they innately possess the knowledge and power to do so.

Do I wish that more babies in the US were delivered by midwives? Absolutely.
Do I think home birth is a safe, wonderful option and should be more widely accepted by the medical community? You betcha.

But like with any other social change, the scales tip one pebble at a time. If I can impact one woman by equipping her with the tools she needs to have a safe, powerful, ecstatic birth, no matter where it will take place, it's a good day.

Thursday, May 17, 2007

What happens if people realize I'm not perfect?

A few weeks ago I sent an email to an old client I had been trying to get in touch with. She had a really amazing birth- one of those that make doulas feel like they really make a difference. The mom and her husband were both overjoyed and extraordinarily grateful, and I went home with a smile on my face.

Four days later my father-in-law died of cancer.

Him and I were particularly close, and his passing fell on me like a ton of bricks. He was living with our family for the last part of his life, so everywhere I turned was a reminder of his life and death. I was in no shape to counsel anyone, least of all someone in the most exciting time of their life.

When I talked to the dad a couple of days after the birth, he mentioned that mom was having some nipple pain with breastfeeding. Since I was not up to a visit, I asked a Lactation Consultant friend to do a postpartum home visit for me so this family did not get deserted in this sacred time. She did, and they were thankful for the support.

A few weeks later I finally called this family. I left a few messages, sent a few emails. Mom had her own familial illness in California to contend with, so after a number of tries with little response, I let it go, assuming that was what they wanted.

When I heard back from this mom recently, she told be she felt dissapointed by my level of care after the birth of their baby. That I had not been there in the way they imagined.
I was totally shocked, extremely upset, and realistically, a little ego shattered. That's the first time anyone ever gave me that feedback, and it especially stung since I genuinely like this couple and thought we had a great experience together.

After much time spent mulling this over, I realize that how I feel or what I think I did or did not do does not matter at all. Who is right is immaterial. A new mom felt abandoned, one that was in my care, and regardless of what happened, I have to respect that feeling. Not because it's right, just because she feels it. New moms need support, love, attention and protection. As labor doulas we need to make sure that after the birth, even if it is not in our scope of practice, that these moms are getting the care they need. As hard as it sometimes is, people hire us to put ourselves aside and be fully present in our clients' lives. She needed me, and although she didn't tell me verbally, had I been there physically I probably would've known.