Hello from the other side…

Hello from the other side.

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I wasn’t going to do a post on Miscarriage awareness month. I have not experienced infant loss first hand;  I’ve never had the horrible experience of losing a wanted pregnancy. I can only imagine the pain people go through.

But I have been thinking about Rainbow Babies.

For those who don’t know, a Rainbow baby is a child born after a child is lost. I guess it is the ‘pot of gold’ at the end of the rainbow. It is the beautiful thing that only comes with the rain. I have mixed feelings about this analogy, because I am a Rainbow Baby.

My mother has said she was pregnant for a year before I was born. She was. She miscarried my older sibling and conceived again so quickly she didn’t really have time to mourn. So what that means is if that pregnancy had not failed, I wouldn’t be sitting here right now.

Chew on that.

I cannot be happy that my mother went through the unpleasant experience of miscarrying a much wanted baby. But I wouldn’t be here now if she had not. And, you know, I like it here.

I have read a lot of posts about lost babies over the past few days, some of them are pretty emotionally devastating.  I am so lucky to have never lost a child. But I’m also lucky that my mother did.

Mixed feelings.

I don’t know if my parents still think about that child that was never born. We’re English; we don’t talk about such things. But I have to be grateful that my sibling didn’t make it, because if they had I would not have.

So, I want to take a moment now to acknowledge that life that was not lived, and say thank you to my lost sibling.

I remember you.img_1321

The Uncomfortable Feminist

 

I am a birth worker,

arguably the most woman-centric job on the planet. I work with women at their most vulnerable, most powerful, most female. Giving life is something only we can do. It is beyond awesome. And yet, women in childbirth are subjected to disrespect, abuse, and downright misogyny on a daily basis. I am confused by the number of hospital staff I have encountered on the maternity floor who do not seem to like working with women. Perhaps a career move should be considered?

As a doula it is my job to support my client. It is not my job to speak for my client, and sometimes I have to sit and listen and hold my tongue while others try to knock my client down. As a doula I have no power, but I try to make my client feel powerful, powerful enough to stand their ground and say “I’m doing this my way” when faced with pressure from those who feel the need to run the show. Sometimes I feel very uncomfortable.

As a doula I am a witness to a lot of underhanded stuff.

As a feminist I want to scream. “Don’t talk to her that way!” “She is an adult not a child!” “You are her doctor not her boss!” I want to say, “He’s not right.” “He doesn’t have the right” “She’s impatient; her agenda is not the same as yours.” I want to say “a healthy baby is not the only important thing. “  I will be misunderstood. A healthy baby is important -but what about a happy and healthy mother? What about an empowering birth experience?

What about respecting the woman as well as the child?

I am a birth worker, and a feminist.  But I rely on my husband’s income to support our family. If giving birth is not respected, how can I expect birth work to be respected either? I believe in the work I do, but my belief doesn’t put much food on our table.  I am told to charge what I’m worth, but if the birth experience is not respected, the worth of a doula is not clear.

I am a doula and a feminist.

I love my work. I do it because I believe choice in childbirth is a feminist issue. I never wanted to be political, but I will fight for this. We were all born. How can we not respect the one thing that we all have in common?

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To Test or not to Test

During a rare quiet moment the other day I stumbled upon this article in the Toronto Star: ‘Over-testing can have a serious downside’. Written by Dr Sacha Bhatia, it’s a quick sum up of a phenomenon we are more than familiar with in the maternity care industry: that more tests and procedures do not equate to better outcomes. His article led me to the website for Choosing Wisely Canada, a new campaign by the CMA and the University of Toronto.  They are encouraging Canadian patients to think for themselves and ask their doctor 4 simple questions:

  1. Do I really need this test, treatment or procedure?

  2. What are the downsides?

  3. Are there simpler, safer options?

  4. What happens if I do nothing?

This is exactly what I encourage my clients to do – use their brain and ask intelligent questions. Think of a simple procedure like the Nuchal Translucency ultrasound most women have around 12 weeks and ask the 4 simple questions.

  1. Do you really need this procedure? This is a test that screens for Down Syndrome and other chromosomal abnormalities. For most women this is the first chance to have a look at their baby and they jump at the chance to do so. But do you really need this procedure? Will you abort a baby with Down Syndrome? If the answer is no then this is not a necessary procedure for you.

 

  1. What are the downsides? If the test indicates abnormalities, you will undoubtedly feel anxious and worried about your baby. The test generally used to confirm any issues is the amniocentesis which is a much more invasive and painful procedure with higher potential risks. So if you agree to the non-invasive NT test, you may find yourself in a position where you are forced to choose to undergo an amniocentesis to alleviate the stress brought on by the first test.

 

  1. Are there simpler, safer options? This test is already pretty safe and simple.

 

  1. What happens if you do nothing? If your baby is fine, then he will continue to be fine. If your baby has chromosomal abnormalities, he will continue to have chromosomal abnormalities.  So this test only affects your peace of mind. It’s up to you to decide if knowledge is power or if you would prefer to stay ignorant.

 

 

So you can see the Choosing Wisely Questions are pretty easy to apply to most maternity tests and procedures.  Take Continuous External Fetal Monitoring in labour:

  1. Do I really need this procedure? This monitors your baby’s heart rate continuously during labour. The research shows that continuous fetal monitoring holds no benefits over intermittent fetal monitoring, and in fact often creates problems. So no, you don’t really need this procedure.

 

  1. What are the downsides? The downside for you is that EFM limits your mobility and forces you to stay in bed or at least in your hospital room. If your hospital has portable wireless units you will have a little more mobility but you will still be expected to stay in range. Being tied down during labour is not ideal. It also steals your thunder, meaning that your caregivers will concentrate on what the monitor is telling them and ignore you.  Sometimes the information on the monitor will indicate fetal distress when there is none. Obstetricians err on the side of extreme caution, so any momentary irregularity in the tracing will cause them alarm.  The research shows that CFM does not actually catch things that IFM does not –but it does appear to cause distress in healthy obstetricians.

 

 

  1. Are there simpler, safer options? Yes, the simpler, safer option is intermittent monitoring with the EFM or even a Doppler.

 

  1. What happens if you do nothing? If your baby is in distress then no one will know. In this case occasional monitoring is the better choice over continuous monitoring or no monitoring.

 

So it’s wonderful that the CMA are on board with this initiative to stop overuse of unnecessary testing in medical care, but what is not wonderful is that

The Women’s Health section does not have a single word about maternity care.

Not a one.

So what’s up with that?

Now, Choosing Wisely had their inaugural meeting at the end of March, 2016, so I guess I should be a little kinder and give them a bit more time, but in the mean time if you feel like I do that there should be a large section on Obstetrics on their website, please visit their site and give them feedback! And please let me know what you said in the comments section below.

5 things to do with a Placenta

Our Design Process(2)

 

Eat it.Our Design Process(4) (2)

Most mammals eat their placentas. Only humans and marine mammals do not. Those who believe in the benefits of placentophagy say that it wards off postpartum depression and helps balance hormone and iron levels in new moms. However there has not been enough research done to support this theory. The internet abounds with recipes – you can turn your placenta into stew or smoothies but by far the most popular way to prepare it is to dehydrate it and turn it into nice neat easy to consume capsules.

Make a painting with it.Our Design Process(1) (2)

If the thought of displaying a print made out of your own blood doesn’t turn you off, consider making a painting out of your placenta. The beautiful, unique patterns of your baby’s tree of life’ make a one of a kind keepsake.

Extract cord blood from it.Our Design Process(3) (2)

Storing your baby’s cord blood is like having insurance against some potentially fatal diseases. Cord blood banks make their money exploiting parents’ fear, and I’m not too keen on the idea of anyone profiting from someone else’s misery. The idea is that if you store your baby’s cord blood and they one day develop leukemia (for example) you can then use that cord blood to heal them. The truth is that any baby’s cord blood would do, and perhaps national free cord blood banks would be a better choice than private ones, allowing more children to benefit.  The chance that your child will develop a disease that could be treated by cord blood is very small, and the price tag for storage is very high. That being said if you are wealthy enough to not be turned off by the price and unlucky enough to need the blood, then obviously it is worth it. Know that if you choose to bank your baby’s cord blood you are also choosing to clamp the cord early before it stops pulsating, and that blood that goes into the bank is blood that your baby might have had better use for right now. 

Plant it.Our Design Process(2) (2)

Lots of people and cultures have a tradition of planting a tree on top of the placenta.  My son’s placenta was used to fertilize a cherry tree and the people who bought our house are now enjoying its fruit.

Do nothing – for now.Our Design Process(5) (2)

Those who follow the custom of Lotus birth do not cut the cord once the baby has been born; instead it is allowed to fall off by itself.  This requires a bit of a commitment as you have to carry the placenta around in a purpose built bag for a few days or a week. Once it detaches from the baby on its own you can still plant it or paint with it but you can’t eat it or harvest it.

 

What do you think? Food, art materials, or medical waste?

 

My story, or: the long and winding road to Doulahood.

Writing a bio has always been a challenge for me.

My career path has been a winding one.

As a teenager I was a budding ballerina but I chose to study Biology and Chemistry at University rather than pursue a dance career. Two years in a Science lab was enough for me to learn that I’d made a mistake.  I took some time off and after  working for three years as a professional Nanny in the UK I took my half a Science degree and transferred what credits I could to York University’s Theatre School and after graduation I became a professional Wardrobe Attendant or dresser.

I often felt that no one really knew what I did for a living (including the theatre managers who hired me.)   But I’ll tell you – I helped people be ready. Not just physically, but psychologically too. I did people’s hair and listened to their problems. I was there for them in the dark when they had 30 seconds to change their clothes but being there, consistently there, dependably there meant they didn’t have to think about that costume change but could instead think about their next lines or dance steps or song lyrics. And doing the same thing every show satisfied my inner dancer’s need for a choreographed routine.

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 I was one of the last of my friends to have kids so I benefited from their experiences, and I knew I wanted midwifery care when I was pregnant, and I knew to call as soon as possible and I was lucky enough to get a spot. Having my own children changed things. You know that it will, everyone says it, but it takes a while to figure out how it changes you.  Working in the theatre and having small children was too hard for me. I wanted to be home with my kids. I don’t want someone else to be raising them, even though as a former Nanny I know that it is possible for someone else to love your kids as much as you do.

A few friends had asked me to be present when they gave birth – to be their doula though the word was new to me then. Experiencing births – their births, my own births, listening to the birth stories of others I meet at drop ins and parks and Baby and Me classes – it has made me more and more interested in working in the birth world.  I’m curious about the differences in OB care and midwifery care and the reasons why those differences exist. I want to learn more.  I decided to do my doula training with Bebo Mia and finally I have found a job that combines all my diverse skills. Changing from a Wardrobe Attendant to a Doula is not so big a jump as you might think. What I loved most about working in theatre was that I was constantly meeting new people, and you can’t get any newer than a brand new baby. I’m still massaging shoulders and egos and telling people “You’ve got this.” I’m still helping people get ready, physically and psychologically.  Maybe there aren’t too many other Dancer/Scientist/Nanny/Dressers in the birth world, but this career path of mine has led me here, and I love it.

Contact me here for more information about doulas and to book your free consultation!

So, what does a doula do, exactly?

Frequently asked questions, doula edition.
So you’ve heard the reports and seen the stats and you know that having a doula increases birth satisfaction, decreases interventions and is just the most awesome thing ever. But what does a doula do, exactly? Of course every labour is different and every woman has different needs and desires. Your doula will adapt to suit your specific requirements. She will provide emotional and physical support, guidance and unbiased information throughout the pregnancy and labour. She will make suggestions on books you might want to read, products you might find helpful and positions that will ease your pain. She will hold your hand, wipe your sweaty brow and tell you that you are awesome.

But won’t my husband/partner do that?
Maybe. Hopefully. But sometimes your husband/partner will be a bag of nerves. Sometimes they will freak out when you cry out. Sometimes they will shriek “Get the doctor in here now!” three hours too soon. Sometimes they will turn white and pass out. Your doula can reassure your partner that the noises you are making and the pains you are experiencing are normal, healthy and to be expected. She can help your partner get over their anxiety and suggest ways that they can comfort you physically. She can stay with you while your partner gets a snack or makes some phone calls. She can reassure you both that progress is being made and that there is no reason to be afraid. She can gently suggest that maybe sitting down now would be a good idea. She can hold your partner’s hand, wipe their sweaty brow and tell them that you are both awesome.

But what, exactly, does a doula do?
Your doula will arrive at the hospital or birthing place within 90 minutes of your phone call. She will immediately check out the space, draw curtains and close doors. She will make sure you are comfortable and not sitting in a puddle of your own amniotic fluid. She will find where the dry sheets and blankets are and make sure you have what you need. She will ask questions to find out how you are feeling and what has happened in her absence. And she will get you up on your feet and make you move around as much as possible. It’s good practice to shift positions every 30 to 45 minutes and your doula will keep her eye on the clock and make suggestions as to new positions to try. In the early stages of active labour your job is to find your rhythm and get your coping strategies in place, and your doula will help you do this. You may not even notice that’s what is going on, but your doula will notice what you naturally do during each contraction and will help you keep doing what is working for you. And if things start to change, your doula will try to help you get back on track, whether by trying a new position or motion or water therapy or whatever other tools she may have in her bag of tricks.

Bag of tricks? Tell me more about this bag of tricks.
Your doula will bring a bag to the hospital that is a bit different from what you bring. She will probably have a heating pad or magic bag which can be quite soothing – if you like heat on your stomach or back when you suffer from menstrual cramps you might also like it when you are in labour. Ice packs are also an option. Some doulas bring their own birth ball and some hospitals provide them. (Others refuse to allow them. Boo.) Some doulas use TENS machines. All doulas have training in comfort measures that include massage, counter pressure and light touch. Your doula will probably advice you in advance to provide your own music, pillows and light snacks. Think about the food and drinks you like when you are recovering from the flu. Some hospitals still refuse solid food to women in labour but will provide soup and jello and fruit juice. 20150822_171946
What if I just want an epidural, right now?
In your prenatal visits you will have made a birth plan with your doula, and if your birth plan says “I want an epidural, right now” then your doula will support your choice to have that epidural, right now. If your birth plan says “I really don’t want to have an epidural” then your doula will gently remind you of your original plan, suggest a different position or hydro therapy or whatever but if you say “No, I don’t care, I want an epidural right now!” then your doula will support your choice to have that epidural, right now. Your doula is there to support you and your choices.

What happens in the prenatal visits?
You are likely to meet with your doula three times before you give birth. The first time is a free consultation session at which you will get to know her a little bit and decide if she’s the right doula for you. The second session will include birth planning and a little prenatal education. The third will most likely include breast feeding education, baby care and postnatal planning. By the end of these two sessions you should feel more confident and knowledgeable about the physiological process of childbirth and how you want to approach it, and you will have faith that your doula will support you in whatever choices you have to make along the way.

How long will my doula stay with me?
Your doula will stay 90 minutes to 2 hours after you give birth. She will make sure you have something to eat and drink. She can fetch any family members you have waiting down the hall, or shoo them away if you don’t want to see anyone yet. She will wait with you until your baby shows interest in breast feeding and help you get off to a good start. And when you are ready, she will leave and let you get on with the business of bonding with your baby.

contact us here to book your free consultation!

Why hire a doula?

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What is a doula?

DOULA : from the ancient greek “A woman who serves”.
DOULA : a woman experienced in childbirth who provides advice, information, emotional support, and physical comfort to a mother before, during, and just after childbirth.
Today we use the word doula to refer to a person educated and experienced in supporting women in childbirth and parenting. Many doulas offer prenatal classes and breast feeding support. Some doulas specialize in postpartum care, and others work with infertile couples. The primary purpose of a doula is to inform and reassure the expectant family, providing them with unbiased information to help them make informed choices along their journey to parenthood.

Why hire a doula?
Numerous clinical studies have shown that women supported by a doula have shorter labours with less interventions. They are half as likely to have a C-section and less likely to use an epidural. They have more success with breast feeding and more positive memories of their birth experience.

What about my partner?

Birth 3
Your doula can help support your partner while you are concentrating on birthing your baby. It is difficult to see your loved one in pain but your doula can reassure your partner that labour is progressing normally and that you are coping well. Your doula can show your partner massage techniques that will soothe you and can stay with you during meal and bathroom breaks.

A Baby Ready doula can be your support during this most important time. Let your doula help you write a birth plan and stick to it (as much as baby allows!) Your doula will help you and your partner remember what you learned during childbirth class, and provide you with information and coping techniques to help you labour in confidence. Your doula will encourage you to ask questions of your medical team so that you move through your labour and birthing informed and empowered. Think of your doula as your cheat sheet for the biggest exam of your life!

5 steps to an awesome induction.

251814_10151795813205514_1168844160_nI know what you’re thinking: “aren’t inductions always awful?” “Don’t you hire a doula to avoid an induction?” “aren’t doulas all anti-intervention at all costs?” The answers to these questions are no, yes and not at all. Sometimes inductions are necessary. Doulas are not magicians. Interventions have their place. Last month I was privileged to attend the birth of a sweet-faced little girl. Her Mother had developed complications and the decision was made to induce at 38 weeks. Here is what my client taught me about how to have an awesome induction.

Step 1. Keep a positive attitude. So your birth plan was to have a water birth at home with midwives, and you find yourself checking in to the hospital for an early induction. Oh well. It’s still your birth and your baby, let’s make the best of it.

Step 2. Take one step at a time. The OB is most likely to offer you gel, AROM, Pitocin, and an epidural as a welcome package. Try to space out these interventions. See if the gel will work by itself. Try to relax, sleep, and let your cervix do its thing. Put off the next intervention for as long as possible.

Step 3. Walk walk walk. Try and move around as much as possible. The longer you can stay mobile, the better position your baby will slip into for an easier birth. Remember, gravity is your friend. There are many upright positions for labouring even if you want to rest in bed. A portable fetal monitor even allows you to shower or get in the bath. You can still move around with ruptured membranes and a Pitocin drip if you are determined to do so.

Step 4. Don’t be a martyr. You don’t have to suffer. Pitocin induced contractions are much harder and stronger than the natural kind. Very few women can manage them without pain relief. Getting an epidural does not mean you’re a failure, it means you can enjoy some pain-free time to rest up for step 5.

Step 5. Wait till you feel pressure on your rectum and push that baby out like a boss. That’s what the epidural does best – gets you through transition without batting an eyelid. If you stop pressing the top up button when you begin to feel pressure in your bum you should have enough sensation to push effectively when the time comes. Slow steady pushing is the way to go.

That’s it, my 5 steps for an awesome induction. Remember, it’s still your birth and your baby and you are the one in charge.