Poems this week

Soft words, gentle touch,

oxytocin highs make bub 

and safely birth bub

 

Hotel Rwanda

Harrowing true genocide

and deep, selfless love

 

Far away bike zooms,

distant dog barks, birds chirp.

Peaceful dawn soundtrack.

 

 

54.

Icey drink, luxe mag

Sweet, crunchy almond shortbread

makes shopping worth it.

Poem 50 and post 1001

 

Waiting for baby, 

perfect birthing time will come.

Sure as the sunrise.

Wise Women of Birth

Photo from Natural Beginnings, V. Maddock

This weekend I went to a workshop to see what wisdom I could pick up from a room full of doulas and four guest speakers: birth workers with a combined 150 years of experience serving women.
Two of the guests were from Portland, OR and I was grateful for my blogging friend Snow who has educated me enough so that I felt as if I had some idea about their part of the world. (thank you!) One of these midwives recounted to me a little of what it was like to attend a birth in the aftermath of the Mt St Helens eruption which I found interesting.
As evidenced by the picture I was deep in thought for much of the day and although my readers here tend not to be a demographic who are particularly interested in the issues surrounding birth we can never underestimate the value of getting good information to anyone who belongs to humanity so here are the take home messages of the day (as I see it)

• We might do well to think about putting more emphasis on the baby and less on pre-birth pedicures and brazilians.
• We need to stop giving women the message that they need help to birth. Doulas are there to affirm the mother's own ability and bear witness to her process, not to fiddle about with evening primrose oil, rebozos, massage oils or "natural induction methods".
• There is no good evidence for the current trend of placenta encapsulation and  no guarantee that it is not harmful.
• Two enormously helpful things any mother can do which are proven to reduce the risk of pre-term birth are to gain enough weight (15-20kg) and to eat plain yoghurt at least once a week during the pregnancy. This improves gut health and produces a favourable vaginal flora, reducing infection risk to mother and baby.

The day was organised but Denise Love of Women's Health Cambodia and featured the owner of the organisation, Chong Nai Hy. Read about their work here.

A Walk to Beautiful

The Addis Ababa Fistula Hospital has been on the edge of my consciousness for some years on and off, especially when it receives media attention. I noticed it a little more when I joined the birth world and a little more again as I realised that a high profile and well respected doula had become the CEO of Hamlin Fistula Australia so when I was given the opportunity to attend a charity screening of "A Walk to Beautiful" I jumped at the chance.
Obstetric fistula is a complication of long and obstructed labours and it causes incontinence (urinary and sometimes fecal) in affected women. These women are unable to work or socialise and become completely isolated by their condition. They are commonly shunned, often rejected by their husbands and sometimes feel that death would be easier than life with a fistula.
The obvious cause of fistula is the enormous difficulty the villagers of Ethiopia have in accessing medical care: many villages are many hours walk from any road and even further to reliable medical help. The documentary makes it clear that the women of Ethiopia are not only victims of poor infrastructure but of cultural norms. Early marriage and childbearing means that mothers are often little more than girls and are physically too underdeveloped to birth safely. Complicating things further, Ethiopian girls and women work very hard, carrying firewood and water from a very young age and although their diets are of good quality they don't receive the calories needed for growth so many are extremely small even when they are physically mature.
The film demonstrates the scale of an almost insurmountable problem but it also showcases the life changing, life restoring work of the hospital as well as the courage and tenacity of some remarkable women.
Fistula became rare in the developed world a full 120 years ago, the first ever fistula hospital closed in New York almost 90 years ago but it is still a major problem in Africa and in other impoverished parts of the world. The film freshened my resolve to be grateful for the privileged life I was born into, to "pay it forward" and to continue teaching my children, especially my daughters, that in no way has feminism finished it's job or become outdated, that in fact, we have only just begun.

As one critic wrote
 "A Walk to Beautiful will leave you speechless two times over — first with despair, then with joy. Neither unmentionable subject matter nor nonexistent commercial prospects can keep this documentary from having a power over your heart that is unparalleled"

Waiting.......

I am on call now for a birth and while i think i am better at uncertainty than the average person, that doesnt mean i have no concerns.
My concerns are mostly manufactured in my own mind: what if i dont hear the phone and they dont call again? what if they have decided at the last minute that they wont call me? what if there is a traffic jam on the way? will i remember everything i need to? will i think on my feet when something unexpected crops up (and it will, it is birth) if it is long, will i be anywhere near useful at the end? what food do we have that i can quickly grab as i head out?
every night when i get into bed i think i am too tired for a birth tonight, every time my son has my car i worry about getting the call, yesterday i worried that i would forget the address.
today i was asked what food i recommend for labour and i worried that i was being either too vague or too prescriptive (i said comfort foods, complex carbs to start and fast energy sources for the end)
i go on call when a pregnancy reaches the 38 week mark and some babies are not born until 43 weeks (rare but possible) it is a long time to be second guessing ones self but this is the life i chose and maybe i will get better with practice?

Let's Do a Re-Think about Power

This photo of a girl in an Afghani refugee camp was taken twenty eight years ago. Some time ago I was interested to read the photographer's account of trying to find the girl twenty or so years later. He met a few women who might have been this girl but if I remember rightly he never was able to be sure whether he found her or not. What I do remember is that the women he found who might have been her were old looking beyond their years and told stories of untold hardship: of marrying as children, the deaths of their own children, of servitude, abuse and zero opportunity, not to mention the horrors of famine and war.

Girls in this world are still enormously vulnerable and while we have things like Female Genital Mutilation, child marriage, honour killings, child prostitution and child trafficking we really need every day to be the international day of the girl.

The reason why women and girls are so badly treated is mostly, I think, due to the fact that they seem to have less power than men. Girls and women are less likely to have economic power through political or business endeavours, less likely to have power through positions where leadership is conspicuous and power is enforced from a position of superiority.

We need to rethink what power is, to view it differently, if we are ever to place real value on girls. As the gender who have babies and are biologically determined to feed that baby regularly over a period of many months or years, in my opinion, if a woman is to follow the biological and instinctive imperative to be physically present for a child for a long period of time, she is at an automatic disadvantage in the business/political world. In extension of that idea, then she is bound to become less powerful in the traditional sense but what if we view power in a different way?

A large part (50%) of the potential intelligence of a child is realised or unrealised in the womb when stress hormones produced in a mother and transferred to the baby can limit brain development in utero (conversely, the baby of a relaxed mother will experience less stress and better brain development) What kind of power is that, to potentially make a child more intelligent? And what better reason to treat women well.

The baby who is breastfed and continuously, reliably  nurtured in it's early life has limitless health benefits both physical and psychological and the child is generally better prepared for a productive life. That factor also means women have enormous power over the well being and success of future generations and all of that power is exercised in the very brief initial years of motherhood but the ability of women to influence their society continues throughout the lives of both the woman and the child.

Girls who are valued, supported and educated don't only confer biological benefits on their own offspring but tend to experience financial benefit and to put that benefit to use for the good of their families and communities, improving health and education from the ground up, producing stronger relationships, and enabling those around them to better find and attain their potential. 

The challenge for all of us, especially in countries where opportunity and privilege are more abundant and where laws and constitutions attempt to achieve equality for all, is to figure out how we can advance the cause of the girl.

Personal transformation can and does have global effects. As we go, so goes the world, for the world is us. The revolution that will save the world is ultimately a personal one. Marianne Williamson

is a doula an indulgence?

only last night my poor sister got caught up in a conversation where she mentioned that i am now a doula and the woman she was talking to was ....um....maybe we could describe it as scratchy. "why do people need support in pregnancy and birth?" was her question. i know the lady is a mother of two and i guess she figures she managed, so should everyone else but there are lots of very good answers to the question:

very simply put, if a lady wishes to be supported by a caring, knowledgeable professional and is prepared to pay for it, why not?

if there is no doula, who will support the mum? there is a general expectation that the father of the baby will act as labour support but daddy might be absent due to work commitments or not feeling up to fatherhood; he might be physically present but emotionally absent due to being overwhelmed or not childbirth educated; he might see childbirth as womens business (for personal or cultural reasons); he might be a marvellous support person but labour might start when he is tired from a long day or it might go on so long that no mortal could be expected to be the only support for that whole time or he might be trying hard but a bit scared and lost. when the dad (or any other bystander) is anxious and producing the hormones of stress and fear those hormones will affect the labouring mum. stress hormones are not compatible with labour and labour will slow or stall, increasing the risks of interventions. 

very often a  mother will invite her own mother/friend/sister to be present at the birth, which can be great but sometimes times these people are not physically close enough to attend or they can bring fear and stress to the birthing room, especially if they have suffered traumatic births themselves. 

even the very best hospital staff can be too busy to be truly available to the mama, sometimes they are lacking bedside manner, sometimes they are wonderful but there is a shift change and everyone has to adjust to a new style of caregiver.

why does mum need support?

if this is a first baby mum faces the unknown and no matter how easy the pregnancy has been, how healthy she is or how well prepared the unknown is always at least a little bit scary. then there are the times when motherhood can be expected to be a challenge: when mum is young and/or unsupported, when mum is a recent arrival in a new land, when dad has left or is difficult to deal with, or is flat out dangerous, when baby is known to have health problems etc.

>in so many situations the mother faces some compromise to her ability to relax and enjoy motherhood. at these times the hormones of stress and fear slow labour and they also course through baby. not only is that unpleasant for bub but the period around birth is a time when baby's brain is extremely plastic and the emotions experienced by the mother/baby at the time of and immediately after birth will predispose that baby to feeling those emotions throughout their life. nobody wants to see mothers endure emotional pain or physically traumatic births and neither do we as parents or society want our children to suffer more fear, anxiety or insecurity than the process of living will naturally bring them.

a smooth (or smoother) transition is good for society!

okay, so if there is a doula the transition to motherhood is supported and baby's journey earthside is nicer but what is the value in "nicer"? 

doula supported birth sees a 50% reduction in caesarean section rates and while its hard to find and compare costs for different births, it is estimated that the NHS pays an extra 800 pound for each caesarean performed. US costs can be up to $10 000 extra for c-section, that is the cost of 5 very well paid doulas! insurance would often cover that cost but when insurance pays, we all pay.
doula supported births lead to better breastfeeding, more confident mothers, reduced post-natal depression, reduced birth trauma, reduced epidural rates and lower incidence of assisted delivery. every single one of these benefits will reduce costs to our society through improved health outcomes and lower out-of-pocket expenses from the very beginning.
and all of that is the somewhat measurable benefit, there is also the long term, difficult to define and measure cascading benefit to mental health and happiness.

for the family who pays for a doula it may seem an indulgence, one of those life enhancing decisions we make but cant quantify the effect, just like eating organic food or having a new car or indulging in expensive hobbies but for society as a whole i dont think they are the slightest bit indulgent, more like an investment in the future of our families and our health. doulas really and truly have the power to change the world, baby by baby, family by family until a ripple becomes a tsunami.

What do doulas talk about?

This week i joined a doula network on facebook. its a weird world and i thought i would share some of the subjects under discussion, just for light entertainment

• does anybody use the word "yoni" instead of vagina?
• does anybody want to buy birthing pools discounted due to flood damaged boxes?
• can anybody make suggestions as to how to help a mum with anal fissures?
• what books do you recommend to clients?
• what should i charge?
• how can i help a mum with extensive vaginal bruising? and one of the answers: if she saved the placenta, she should eat it

every profession has its own culture but i think that in this one it will be a very long time before i have "seen it all"

You learn more about a thing when it doesn't work than when it does

I was reading a the blog of a UK doula this week, she was talking about what distinguishes a doula from any other person a mother might choose to accompany her through birth (friend, sister,  chiro, etc) and she wrote:


"She has most likely given birth herself. This is not true of all doulas, but for me it would be essential. At least one of her births has been a positive and transformative experience"


*click on the quote to read the full article

I was a little taken a back for a second when I read that, you see the idea of an ideal or positive birth is one that is minimally intervened in, where baby and mother are well, bonding is well supported and breastfeeding is established. I did actually give birth that way once out of my three pregnancies but the birth that transformed me was not that one, it was rather different to the picture of ideal and I don't wish to painfully recount that story because the details are only of interest to me but what i will say is that my transformative birth was long, there were many interventions, my baby spent time in special care and I could barely sit for a while but it was the challenging nature of events that made it positive and transformative.

Through that birth I learned the value of a support person, I wont ever forget the strength I drew from the midwife, the strength I hope to offer to my own clients at the right time.(I still remember her name, Alison).

I learned that I could pass through a difficult time and be whole at the end.

I learned that I could go into labour spontaneously and progress towards birth. As it happened I needed some help at the end but I was still left with the confidence that as a woman I was designed to have a baby and the design worked.

When my boy was finally in my arms and nursing I was quite confident that I could be a mother to him, that might have been oxytocin doing it's job or it might have been total naivete, whatever  it was, that confidence waned at times but never completely left and it has served me well as a mother to him and the babies who followed.

My less than ideal birth experience was both positive and transformative, who would have thought?

eclecticism strikes again

since my promotion to housewife extraordinaire i have been doing the fruit and veg shopping at the major sydney markets, open to the public on a friday. i have searched the internet for a photo i could steal but my fave pics are unstealable so instead i'll recommend you take a tour with this blogger who i will now be bookmarking. the photos are more than atmospheric. 


at the markets today, after an absence of two weeks, i got a little carried away and came home with a lot of brightly coloured, anti-oxidant rich, sensual looking food. i have plans for slow cooked beetroot, pumpkin soup, ratatouille, fresh from the bowl mandarins, banana sandwiches on soft white bread  (white bread has it's uses) rocket salad and mushrooms in butter and garlic. and i'm excited about it all. in my imagination i am Nigella.


the baby whose birth i will attend as a trainee is due in under a week and all the major players agree that a saturday, pre-mothers day appearance would be nice. i'm not sure how the bairn would be feeling about that, i guess his compliance will be measured by whether or not i get a call  in the wee hours tonight.


tonight! i could be attending a birth tonight! or any day soon. it's scary and exciting all at once and i have had to review my mobile phone habits to be sure i am contactable. never more will i be able to say it wasnt charged, turned off,  left in the car, dropped under the bed or in any other kind of unoperational state. 


my very first ever solo client visit was yesterday and in the scheme of things i think i did a good job but i'm noticing that my filter needs some minor tweaks: i almost blurted out something scary about prolapsed cords, thankfully i caught that one and i could have been a little more finessed and eloquent on other matters......


life isnt a dress rehearsal though, is it?


have a brilliant weekend, all

still immersed

yep! i'm still up to my ears in doula stuff. i have read and talked so much about childbirth that i am overloaded and everyone around me is too but i dont think i will be letting up any time soon (sorry) i am almost finished the first part of my course which means i soon have to cough up some dollars for the second part.

it's enormously exciting and terrifying in a good way and i fear i will become more and more ostracised by my hippy mentality which was always there but is encouraged every day by my increasing awareness of just how amazingly perfect nature's design is (and i know nature makes mistakes and i am not advocating irresponsibilty, just a greater faith in the scheme of things)

the whole doula thing sits nicely with my unashamed and total romanticism as well as with my no beating round the bush-ness. talking of beating round the bush....surely that could be twisted into some kind of birth related witticism?

if you would prefer not to talk to me about doula-ing, childbirth or other weird hippy stuff i'll be pleased to join you in some other conversation. just dont imagine i can initiate it!

A mother to the mother

I have been effectively unemployed for quite a while now. I did a day or two's work back in about late november, i think but nothing for a while before that and nothing since. I took some time to be gentle with myself and be a more attentive mother and generally recover from the trauma of a couple of years as worse than persona non grata. I have applied for a few jobs, even been to a couple of interviews but i havent had much success and if i was completely honest i couldn't get excited about any of the jobs i applied for but this week i had a revelation. i think it was truly a revelation, too because my inspiration to look into becoming a doula* seemed to come directly from something outside myself.

For whatever reason i googled "doula", i read, i thought, maybe more importantly i felt and it felt right. I told my chiropractor of my idea and her excitement was spontaneous and encouraging. emboldened to continue i asked her whether she could recommend a trainer or point me in the right general direction and she did! she gave me the name of a woman who would surely know which doula trainers were best, i phoned the woman and she actually has her own doula training program which i wasted no time in signing up for.

and so, by a miracle of inspiration and circumstance i find myself on the brink of a new career, at once petrified and thrilled beyond belief.

it's a funny thing, i always say things can turn in a day but i didnt imagine that i would, in the space of a day or two, go from being in an employment wilderness to prospectively being employed to help people through the miraculous rite of passage that is birth.

*the word doula comes from the greek and refers to a female servant. the modern incarnation of the doula is as a source of support, information and advocacy during pregnancy, labour and birth, sometimes with the addition of post natal care and advice.