Wherein I reveal that I am truly a geek. But at least my kids are cute.

Angela, at her friend Rusty's birthday party:

Angela: "Happy birthday!"
Rusty: "Happy birthday!
Angela: "Actually, it's not my birthday, but thank you."


Conversation at church:

Angela: "Smell my breath!"
Me, teasing: "Eww!"
Angela: "Now smell me."
I smell her neck and she giggles.
Angela: "Now smell something not on my body."
I pick up her hand and sniff it and she laughs.
Angela: "Nooo! Not on my body! Smell the church."
I breathe in deeply (smelling nothing) and say "Ahh."
Angela: "It smells YUCKY! because I tooted!"

What I've been doing:

• Getting ready for next week! We have family coming in to town for two weeks over the holidays. That means Thanksgiving and Christmas preparations this week. Whew!

• Reading! I've been devouring books lately. And I achieved my goal of finally, finally, finishing Pride and Prejudice.

• Teaching! I have had the opportunity to see fear turned into confidence as women learn about childbirth. In discussions and classes, those who worried about what would happen during birth, avoided learning about it out of fear, and then found out that their fears were exaggerated...it is thrilling. It reminds me that though we often avoid the things we're scared of, we might find, through facing our fears, that they're not nearly as bad as we'd thought. We shouldn't let fear keep us from the truth.

• Feeding my 70's sci-fi appetite! Rob and I have been watching as much of Solaris as we can stand, and I have to say that watching a creepy movie before bedtime helps with the nighttime cuddling.

So, if there was ever a week beyond July 2007 to geek out, this is definitely it.

Two days, two births, two amazing moms

I make a point not to publish much about my clients' birth experiences, to protect their privacy. You never know what details someone might be hesitant to share.

This week, I managed a total of 19 hours of labor support over a day and a half, for two mothers. Their babies were born 15 hours apart. Both were incredible experiences, for me, their doula, and hopefully even more so for the moms and dads.

One mother was in labor for twenty-four hours before she was dilated and pushing. She began labor at 10:30 pm Monday night and had her baby just after midnight on Wednesday morning.

Later on Wednesday, my other client's water broke. Her baby was born around 3:30 pm.

I had prayed that these two women, who were both overdue, would not go into labor at the same time. I prayed that their labors would not overlap. They didn't, though I realized later that their babies were born on the same day.

The positive experiences far outweighed the negative ones. In fact, I can't remember much negativity at all.

The best parts for me were:

• Both women used spontaneous rhythmic rituals to cope with labor. This tends to happen in late labor with unmedicated births. Each was different and unexpected, as unique as the mothers themselves. At one labor, I was so happy to see it and know what it meant, where the mother was in her labor, that I started to cry.


• Both women reached a point where they visibly surrendered to labor. They both clearly came to a place where they had to fight it or give in; they both surrendered, and labored well, even better than before that moment.


• One woman, not fully dilated and with a posterior baby we were trying to rotate, resisted the intense urge to push for more than an hour. The effort nearly made her throw up. I had my hand on her hip, pressing to ease the back pain, and I felt how powerfully those muscles were working. That she held back at all, especially for as long as it took, is remarkable.


• One woman had her best friend catch the baby and bring the infant up to her.


• I saw a posterior baby turn to anterior just before crowning. I watched the head turn around rapidly, 180 degrees, to the best position just before birth.


• One mother nearly had dystocia, with a baby's shoulders stuck while the head was out, but the baby came free quickly. The mother had no tears or scrapes at all.
  

• I saw struggle, stress, and agony turn to complete exhilaration as a mother held her new baby and realized what she had just done.


• Both women got everything they had discussed with me that they wanted out of their births.
  

What does it mean to me, to be a part of all of this? First of all, I often feel I am nothing more than a witness to miracles. I don't do the birthing work. I try to keep the women anchored, remind them that what they are experiencing is normal and natural, and that it is all to get their babies into their arms. It's very easy to forget these things, even from one contraction to the next.

Other than that, I have become more and more aware of my own powerlessness at births. So much depends on the mothers, on their ability to endure discomfort and uncertainty, to let go and be alright with not controlling what their bodies are doing. That moment of surrender I recognized in each experience is the dividing line between the typical, intellectually- and emotionally-balanced experience, like we have most of the time, every day, like now, and a primal, uninhibited, completely visceral experience, the state that women enter before babies are born. Women in that place often stop caring about things that bothered them before, like whether their bottoms are exposed or worry about pooping or leaking fluid or what kinds of sounds they're making.

None of that has to do with me. It's the mother's journey. I can help her with her breaths, her visualizations, her physical comfort, and establishing an early ritual, but once she reaches the point of surrender, she teaches everyone else what works for her.

Both of these women are made of stronger stuff than anyone could have anticipated. Both went though intensity I cannot imagine to have their babies, their births, in just the way they wanted.

Because of me? Absolutely not.

But I'm so glad I was there.

Healthcare: an oxymoron...

Just like in any profession, some nurses are fantastic, and others are evil.

I have had the opportunity to attend two births in the past ten days. Here are some of the things I heard while assisting women through childbirth:

Nurse, seeing that contractions were five minutes apart: "Must be this natural thing."

Same nurse, to the mother: "You have a poopy uterus. It just isn't doing its job."

Nurse, while admitting the mother, during a difficult contraction: "Do you know your blood type? Do you have any allergies? Who's your pediatrician?"

Nurse: "The reason we don't want you to eat is really for your sake. If you eat you might get sick and throw up, and if you need a c-section, you can throw up and it might kill you."

(Actually, the main reason for the 'no food during labor' rule is because nurses don't want to be vomited upon. Only general anesthesia -- very rarely used for c-section anesthesia anymore; they mostly use epidurals or spinal blocks -- have the vomit aspiration risk. Nausea and vomiting are normal and healthy during labor, and carry far less risk than food deprivation.)

Nurse: "These contractions just aren't working."

Mother: "I really don't want an IV. Is there anything else we can do?"

Nurse: "I've seen babies get very, very sick. It's very sad. You don't want to take that risk with your child. This medication has no side effects and it will help you and your baby. You don't want your baby to get sick, do you?"

Nurse, one hour into pushing, mother's first baby: "If your contractions were stronger, you'd have your baby by now."

(Two hours is the average time spent pushing for a first baby.)

On the other hand, I've seen and heard some amazing things during the same births:

• One nurse held the EFM on the mother's abdomen for twenty minutes rather than place the straps around her, because she understood that it was uncomfortable for an unmedicated mom.
  


• A doctor suggested nipple stimulation to encourage contractions.
  


• A first-time mother pulled her baby out of her own body once the shoulders were born.



• The nurses dusted off the squatting bar for extensive use.



• One nurse suggested walking and side-lying, which were exactly what was needed.



• The no-eating rule was not enforced.



• Two nurses had a murmured conversation about Higher Authorities: "We aren't the ones in charge here." "No, we're not. We never are."



• One mother declined all shots, eyedrops, and immunizations, and did not meet resistance from the staff.



• After seeing a small circle of the baby's head for an hour through a stretched perineum, the father asked, "How is this possible? How is this going to happen?" and the doctor replied, "It's a freakin' miracle."

Yes, it is!

Though I wish it was a miracle with the support of the nurses instead of in spite of them. If it were my decision, some of those nurses would be severely reprimanded, if not barred from delivery rooms altogether, for making those comments.

My review of The Business of Being Born

Over the weekend I saw a screening of Ricki Lake's film about birth, The Business of Being Born.

I was hoping it would be a fairly educational film about harmful hospital practices and routines, and ways of circumventing the system to have the birth you want. It partially fulfilled my requirements.

The film was lovely. Most of the births were just beautiful. They made me want to be in labor.

Much of the information was accurate and poignant. They cited the high cesarean section rate in this country and talked about the snowball effect of hospital interventions and how rarely medical staff see births that proceed naturally, on their own, without augmentation or interference.

Good stuff. If you haven't heard it before, it makes you think.

Interviews with Dr. Michel Odent, Ina May Gaskin, and Robbie Davis-Floyd were wonderful. They seemed like old friends and I wanted to hug them. Dr. Odent is amazing.

However...

There is an obvious bias throughout the film, and because of this I no longer call it a documentary. It is more like propaganda, and while I do not disagree with the basic message it's trying to promote, I find its tactics dishonest enough to be objectionable. It ends up portraying that "home births are always good and hospital births are always terrible," which is not true.

Home births are generally safe; I'm not arguing that here.

But they can be scary, too. Not every woman is able to or should have a home birth. Women should be where they feel safe; otherwise they won't labor as effectively.

Hospital births are not evil. You must understand what is happening, seek a care provider who will meet your needs and work with you, and fight harder to have things the way you want. But being in the hospital, all by itself, is not a bad thing. I believe we've come to a point of crisis in childbirth because of something else in the culture:

The greatest evil, one that was not addressed in the film, is the profound lack of education among women about birth.

It isn't for lack of educational opportunities. It's a dangerous complacency, a feeling of laziness and unwillingness to learn. Without knowing your options, not knowing the risks and benefits of common procedures, you are potentially like a lamb going to slaughter, no matter where you birth. You will not know what to expect or understand the kinds of effects anything might have, good or bad, on you and your baby.

It's not a good situation for anyone.

But I digress. This problem wasn't mentioned in the film. (Neither were doulas, which was personally discouraging for me.)

Instead, OBs claimed that c-sections were safer for all women, midwives talked about being too empathetic to he helpful to laboring moms, and the film ended with the emergency transport and c-section of the film's director for a rare complication. How many women left that night feeling more anxious about labor?

It isn't as simplistic as the film portrayed. Place of birth matters, but what matters more is education. If you aren't educated, you won't be able to make any decisions with confidence. And birth, no matter what happens, no matter how it proceeds, will deeply affect you. You will always remember how you gave birth.

It's a film worth seeing, for the things it gives women to consider. It will be available on Netflix in February. But keep in mind that these things aren't quite as simple as portrayed.

Doula training

I have done hard things before. Getting through labor and birth was tough. I wanted to give up many times, and in my second birth, if I had been able to speak, I just may have said something like this: "Anything...give me....anything....drugs....don't care...". Ah, Mother Nature has a plan for everything, doesn't she? I couldn't talk, and consequently I had a natural birth.

I don't regret that. Not for a minute. I am so pleased, so proud of myself, and deeply grateful to those who were there to help me through it.

It's a strange thing, to be in the middle of suffering, wanting nothing more than to be free from suffering. Then when it is over, you realize you could have gone on much longer, that you were really nowhere near your capacity to handle it.

I tell my three-year-old all the time "You are capable!" I have started telling the mirror that same thing, every morning. You are capable. You can do this.

I have given birth. Naturally. Twice. Surely I can handle being a stay-at-home mother.

What I teach mothers during labor as a doula can be used throughout motherhood:

• How to relax.



• If this isn't working, change positions/do something different.



• Do not think ahead to the next contraction. What do you need to do right now?



• Have a plan before labor begins; once it starts, it's too late to plan what you're going to do.

Heartbreak

It has been several months since I have attended a birth. I have participated in many discussions about childbirth, and I have taught two series of childbirth education, and consulted with many women about their births. But I have not helped any one through labor in a very long time.

I am feeling the void.

It feeds my soul to attend births. I don't know why; all people have talents and enjoyments, from painting to sports to historical research, and none of us chose what we like. I love the world of labor, and I love spending time with women in labor. That sounds strange, but there it is. I love labor and birth.

So I am feeling the lack of it.

Last night I received an email that rubbed salt into that void:

...we are planning on having a unassisted birth ...We are looking to have a doula who would just be there for support...We would like to know if this is something that you would be willing to work with...

Oh, cripes.

Unassisted births are the extreme end of homebirths. These are births to which no care provider -- no midwife, no one -- is invited. Women give birth in their homes, without any medical help whatsoever.

As birth is a normal process, it usually goes well. Not many things can go wrong with birth. Really.

The things that can go wrong, tend to do so quickly. And without a qualified medical person there to recognize it, a happy, normal experience can turn aberrant and debilitating.

I am not necessarily anti-unassisted birth. I have a very good friend who has had three homebirths, two of which were unassisted. I have a huge amount of respect for her, and because of her I have learned a lot about it.

Those who choose to birth unassisted are typically very well-read and well-researched. They learn as much as they can, because they are not allowing anyone -- no doctor, midwife, nurse, nobody -- to hold the responsibility for the outcome of their birth except themselves. They take excellent care of themselves. These are generally good things.

However, it is not difficult to imagine the scenario where an unassisted homebirth with a doula in attendance meets complications. If something were to go wrong, saying "but I'm not medically-trained and couldn't have known/helped/recognized/taken action" will not prevent serious litigious fallout. There is precedence; it has happened before.

It would be horribly irresponsible for me to enter into a contract of this nature. It would be outside my professional guidelines to do so. It would put my career and family at risk.

But oh, my heart aches. I would love to attend this birth. I wish I didn't have to say "no." There is simply no way around it, though.