Sunday, May 24, 2015

Volume 2, Issue 4 - May 2015

Dear CBI Students,

Did you know that May is the Month of the Midwife?  5 May is the International Day of the Midwife aimed at supporting midwifery care around the world and educating the public on the midwifery needs of women world-wide.  If you want to learn more about what is going on with midwifery care, please check out the International Confederation of Midwives page.
Did you celebrate in your community?  I spent the day running around the island attending prenatal appointments with my senior midwife.  We celebrated each other with a hug and a kind word and then got back to work!
Look at this gorgeous preggo belly!
I hope that May has been bringing you many chances for learning and self-reflection.  I was able to attend my first birth as a student midwife and it was pretty incredible!  It's amazing how well a woman can labour when she feels so safe and supported.  I have a few doula births in hospital coming up that I'm trying to wrap my mind around now.  I'm finding it harder and harder to switch back and forth from hospital doula to homebirth midwife.  If you attend births both in homes and in hospital, how do you manage to switch out your mindset and support the women in the different environments?



In April, I attended a client at a hospital birth.  After that birth, it took me a week of self-care to stop having flash-backs to the trauma I witnessed.  My client desired a gentle hypnobirth but chose a care provider that I had never seen support anything other than an active managed birth.  We discussed the doctor's typical way of handling birth many times during our prenatal meetings, and explored the option of other care providers who were more supportive of a gentle birth.  But my client didn't want to change care providers and since her doctor assured her that her desires for birth were fine with her, she assumed that her birth would go the way she planned.  And the labour part (when the doctor was out of the picture) was beautiful!  

Once the doctor entered the room, everything changed.  And just as I feared, the gentle birth quickly turned into a very active managed birth.  I watched the doctor quickly cut an episiotomy without informing the mother and then lie to her and tell her that because she has a really short perineum, she had torn.  I watched her clamp the baby's cord straight away and then hold the cord up and tell the mother that it had stopped pulsing so it was okay to cut.

When the doctor cut the episiotomy and when she clamped the cord and lied to the mother about both things, what was my responsibility as a doula?  Was it my responsibility at the time to yell out "she's cutting you!" or, "she's lying, she cut an episiotomy!" or "she clamped the cord, she's lying!"?  In the moment it is so hard to know what we're meant to do.  

The political situation where I live is such that if I argue with the nurses or doctors I can easily be banned from the hospital.  We have to pass through an interviewing process in order to be able to provide doula services at hospitals.  So, the doulas are put in the precarious position of speaking up and no longer being allowed to support clients, or going along with whatever is done to their clients.

Afterward, my client, unaware of the lies the doctor told her, felt great about her birth.  And for the most part, it was an amazing birth!  And I wanted her to go with that, to focus on that.  But is it right for us as doulas to only focus on the positive?  To skim over the negative parts of the birth, to reframe our client's birth experiences so that they walk away feeling whole and strong?  What would happen if we told them the truth of what occurred to their bodies and their baby's bodies?  Is it our "mandate" as doulas to make a woman regard her birth experience as a positive one?  Sociologists Bari Meltzer Norman and Barbara Katz Rothman are quoted in Jennifer Block's book, Pushed, as stating, 
"the unanswered, fundamental question is whether (doulas) are making birth better for women, or just making women feel better about their births"(Pushed, p. 160).  

How much trauma can we prevent in our prenatal care with women?  In our reflective practice, we are required to address the actions we take which lead to the outcomes we experience.  If our clients are given the information we provide through the WIGWAM guidelines and still choose a care provider who doesn't align with their goals, what can we do?  If you understand what is likely to happen, do you feel right in telling a client that you can't support her if she chooses a certain care provider?  What can you do at a birth to help a client meet her goals while her care provider is not supportive and quick to do the opposite?

Such as the case with my client, often times it is those who are witnesses who end up absorbing the impact of the trauma and not actually our clients.  In Block's book, she states that  "there's no research to date on the secondary psychological effects to birth attendants who witness traumatic births -- partners, doulas, nurses.  But many report similar symptoms, nagging feelings of grief and loss and anger following a traumatic birth.  Ina May Gaskin calls these individuals the 'walking wounded'" (p.147).  When we witness the trauma, either with our client or for our client, we are left with the burden of what we've witnessed.  How do we process the experience?  For me, I have a group of trusted birth professionals that I can share with and receive loving care.  I journal about the experiences.  I find that until I write it out, I carry the heaviness of it around with me.  Writing it out on paper allows me to unpack the trauma a bit.  I focus on eating well, getting a good amount of sleep, and also getting out into nature.  These three things can often re-set my internal compass and help me find my groundings.

When we work with women who do feel the trauma of their birth or immediate postnatal experience, we need to make sure that we are not carrying our experience of the trauma into their stories.  Our experience will be different from theirs and we need to leave our baggage at the door before we enter into their space and listen to their story.  Doing on-going postnatal or breastfeeding work with a woman and/or partner who is processing her traumatic experience can be heavy for the care provider.  It can be hard to continually sit with a family experiencing trauma and not let it overcome you.  This is why it is important that we do work through the trauma.  Deal with the trauma we experience as it comes to us so that we don't bring it into our work space, and so that we don't become so overwhelmed with all the trauma that we can no longer effectively support these women and their families.

The Department of Anesthesiology and the Department of Surgical Intensive Care at Peking University First Hospital, Beijing, China are reporting that epidural anaesthesia during childbirth reduces the risk of postnatal depression.

Dr. Katherine Wisner, a psychiatrist at Northwestern University, Chicago said:
"It's a huge omission that there has been almost nothing in postpartum depression research about pain during labor and delivery and postpartum depression.  Pain control gets the mother off to a good beginning rather than starting off defeated and exhausted."

Read through the article and reflect on the who is doing the research, what type of birth is normal in their community, and how epidurals may help some mothers reduce the risk of postnatal depression.


We are so glad that you have joined us on your journey

  • Sarah D., USA - Postpartum Doula, Breastfeeding Counselor
  • Brandie C., USA - Postpartum Doula, Breastfeeding Counselor
  • Renee C., USA - Birth Doula
  • Bethany P., USA - Birth Doula, Breastfeeding Counselor
  • Kathryn B., USA - Birth Doula, Postpartum Doula
  • Jenny B., USA - Birth Doula

We wish you much love and success in your endeavors

  • Maggie E., USA - Certified Postpartum Doula
  • Andria P., Canada - Certified Postpartum Doula
  • Cathee J., Hong Kong - Certified Postpartum Doula