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I recently welcomed my fourth child into the world

I am absolutely ecstatic to announce that I had my fourth kid, and 2nd daughter in January 2015. She was welcomed into the world by her older brothers and sister with so much love.

Of course as a doula and prenatal teacher, I was very interested in putting all the skills I teach in my classes to good use in my own labour.

First of all, right from the beginning of my pregnancy, I wanted to choose the best health care provider that would be a good fit with my birth preferences. This is one of the most important things I tell my clients that will affect the kind of birth you have. Don’t just choose any random maternity care provider. Find the ones who best fit with the kind of person you are, and the kind of birth you want.

Secondly, birth can be unpredictable, so when things don’t follow the textbook version of labour, you have to make informed decisions regarding what to do. There are ALWAYS options. When my water broke and my labour didn’t start for over 24 hours, it was stressful because, of course, as a mom, you naturally worry. But I kept reviewing my options and the potential risks of all the options available and kept discussing things with my midwives. Just to be clear, I felt totally fine with having any medical intervention that was clearly necessary and helpful, but I also know when interventions are not entirely necessary. There are always risks to both sides – having a medical intervention or declining it. In my situation I had the options of going to the hospital to start an induction, using non-medical ways of starting labour (herbs/ acupuncture etc which can be highly effective), or simply waiting it out. That’s another reason moms love having a doula with them in pregnancy and labour – if unexpected situations arrive, the doula can often talk moms through the decision making process, empowering them with a range of information on options so that moms can make an informed choice and feel good about it.

I knew the risks and possible outcomes of all scenarios and decided to take various herbs to get labour started. I also know that emotions and ’emotional blockages’ can have a huge impact on labour. So with the help of my doula friend, I worked through any deep seated emotions I was having that could have been blocking my labour from starting. That was EXTREMELY helpful because after I realized a huge emotional block I was holding, and then let it go, my labour started soon after.

Thirdly, of course, is all the pain coping strategies I teach. Once labour started, the first half was the easy part. The key for that is to keep focussing on staying completely relaxed. Holding on to any tension or resistance will cause pain. I was able to feel no pain at all for the first half of the labour by breathing out all the pressure waves and making a low toning sound. You can try it now, just let yourself sigh with a deep sound. You naturally let all your tension go and you feel more grounded. Remember fear in labour = adrenaline = pain = more fear = more pain. You have to keep the adrenaline out of the equation in labour and keep deep breathing away any tension or pressure you feel building up. Pay attention to your body.

homebirth labouring mom As contractions intensified, I moved around, feeling for whatever positions felt more comfortable. Sitting, squating, standing, lunging, leaning forward on furniture, sitting backwards on the couch, swaying my hips etc. I was chatting with my doula, friend, mom, and midwives in between contractions. Eventually, I felt like leaving the living room and going up to my bedroom. In labour, women naturally experience a going within. They feel like they are going deeper and deeper inside themselves as labour progresses. A woman starts using more of her primitive, instinctual brain and less of the cerebral cortex. It is the instinctual part of the brain which controls the natural process of labour. Labour flows more smoothly when a woman is undisturbed so she can smoothly go deep within herself. Any distractions that pull a woman out of this state of mind will slow down the labour and also create unnecessary pain sensations. Bright lights, too much talking, asking questions, talking about time (which is a cerebral concept), telling a woman what to do so she can’t listen to her own body’s instincts, disturbances like frequent blood pressure checks, vaginal exams etc. will all take a woman away from her “labour land” state of mind. And to the labouring woman, this feels quite irritating.

I told my midwives that I wanted a very hands off approach to my birth. I didn’t want any unnecessary disturbances such as internal dilation checks or them telling me what to do. But having them there in the background helped me feel safe in the rare situation where medical help might be needed. It is important for birthing moms to feel safe and supported. That will lead to a smooth labour process. Anything that makes them feel worry, fear or anxiety will cause a slowing down of the labour process, or even complications.

homebirth labouring momOnce I got to my bedroom, the lights were off with just a dim light on in the bathroom. My older daughter had woken up by this point and she lit some candles to add to the mood of the room. My mom made sure the music playlist I had put together for the birth was still playing. I had complied a series of songs that I found both inspiring and relaxing. I love music and I find it helps me set the tone for focusing on feeling good. In labour, you want to take your attention off the pain sensations and replace them with anything that makes you feel good. My doula was massaging my sacrum while holding a hot pack on my lower back. My husband rubbed my back and shoulders. That all felt really good. By this point, I was not feeling zero pain, like in the earlier part of the labour, but all these things helped take the edge off the intensity of contractions so they were completely manageable.

People often tell me that I’m brave to have a homebirth. Nothing could be further from the truth. The truth is, in terms of pain management, homebirth is often easier to manage because I feel more comfortable at home and there are so much fewer disturbances to my instinctual state of being. In terms of safety, solid evidence shows that homebirth is as safe, if not safer, than hospital birth, as long as it’s a healthy pregnancy, there are trained care providers in attendance, and a hospital is less than an hour’s drive away if there is a need to transfer. Here in the lower mainland, BC, Canada, we are so lucky to have a fantastic midwifery system that functions relatively smoothly at home or hospital. If you feel more comfortable having a homebirth, definitely go for it, or at least look into it. If you feel safer and more comfortable in a hospital, then hospital is the place for you. Birthing moms should be in the place that is more conducive to them feeling safe and supported. You have to know yourself, and know what you prefer. It doesn’t matter what anybody else does. It only matters what kind of experience you want and how you’re going to get it.

waterbirth home birthEventually, my contractions got pretty strong and I wondered if getting in the bathtub with warm water would help. I wasn’t particularly planning a waterbirth, but I always keep my options open. The warm water does take the edge of, but of course, labour is still a pretty intense and powerful process. At one point I joked with my midwife, “So you brought an epidural with you, didn’t you?”

“Yeah, it’s just in my back pocket,” she smiled.

“Oh good. I wouldn’t want to be crazy enough to have a natural birth.” ūüôā

(Just in case you didn’t know, you can’t have an epidural or any other drugs at a homebirth because of the risk those things entail.)

I remember, through one contraction I just swore the whole way. Then for the next one I struggled to remember what the purpose of all the pain was. Oh yeah, to open the cervix and let the baby out. So I started chanting “Open, open…” through the whole contraction, while visualizing my cervix opening fully, quickly and easily. Soon after that I started to feel worried. I had the presence of mind to remind myself that this was a normal emotion during transition (the last bit of the dilation phase before the pushing phase). I was worried that this would go on forever and the baby would never come out. It’s common to have this rush of irrational feelings in transition, and a doula often reassures a labouring mom that this is a natural part of the process and it’s good sign that means things are progressing. It is important for the mom to go back to her state of feeling safe and relaxed instead of letting the worry and the adrenaline intensify. Again, smooth, fast and instinctual pushing phase vs. prolonged and worried pushing.

homebirth, waterbirthI soon began to feel “pushy”, meaning I felt like pushing a little at the peak of each contraction. I let the midwives know so they could get ready and everyone else too. My younger two kids were woken up so they could be present for the birth. I tried different positions in the tub – on my back, side, hands and knees, until I found the most comfortable position for myself, which just happened to be squatting facing the width of the tub instead of lengthwise so my feet could push against the side while my back rested on the other side.

Pushing contractions feel different than dilation contractions because you’re not just trying to relax through each one. You’re actually actively pushing with each one. And in a drug free birth, you can feel the powerful force of your body pushing instinctively. It’s not something you can stop. It’s like one mom said, it feels like you’re body is just vomiting the baby out. It’s so strong and so involuntary. In a drug free birth, no one has to tell the mom how to push. Her body just does it. Pushing feels way more fun than the dilation phase before it. I felt very powerful.

Once the baby’s head was low enough in my pelvis, I could feel it. It was definitely a strange sensation and I exclaimed to all the 10 people who, by now had piled into my bathroom, “It feels like a bowling ball.” I put my finger in and felt the top of the baby’s head less than an inch away. A couple more pushes later and I could feel her head crowning. This feels like a burning sensation as the perineum stretches around the baby’s head. I expected this part to take a while, as it can take several pushes to slowly push the head out. But my body just kept going and in one push she went from completely inside to completely out. I had planned to catch her myself if possible, but she came so fast. No one was quite ready for that. Luckily my husband was speedy quick in catching her and lifting her out of the water and onto my tummy. She was happy and content sitting on my tummy, looking around.

homebirth, waterbirthWe hadn’t found out the gender, so it was very exciting to look down and see it was a girl. My daughter finally got the sister she had been hoping for for so long. Here’s the picture that captures the sheer intensity of emotions of that moment right after birth – relief that it’s over, exuberance over the new person you are meeting, and for me the shock of how fast she came out and surprise that I got the girl I wanted.

It was a lovely family experience to have all my kids there, my mom, sister-in-law and friend. My husband caught the baby, my daughter took the photos, my older son cut the cord and my younger son helped the midwife weigh the baby. My kids will all grow up knowing that birth is just a normal, natural and safe part of life. Not something to fear. By the way, I wanted to wait till after the placenta was out to cut the cord, or at least until the blood in the placenta had finished pumping to the baby, instead of cutting the cord immediately. This is so that she can get her full blood volume and have a gentle transition to life on the outside.

Once I got out of the tub and walked back to my bed, I birthed the placenta and breastfed my baby before letting everyone else have her for some cuddles. My mom made me a nutritious, yummy smoothie with a tiny piece of placenta blended in. Having a bit of placenta reduces the risk of postpartum hemorrhage.

It was a lovely morning. I stayed in bed all day snuggling my new sweetheart. And the other kids were just over the moon excited with their tiny sister. Plus they got to take a day off school. ūüôā

newborn baby holding mom's finger

 

 

 


 

Join me on my own pregnancy journey

Hello everyone,

baby bcbaby bcSo I have some exciting news! On Mother’s Day 2014, I found out I’m expecting my fourth child.¬†mom and baby vancouverbaby bcbaby bcbaby bc

I’d love for you to join me on my pregnancy journey. I know you’re going to learn lots along the way.

For those who don’t know me, I’m a Birth Doula and Prenatal Teacher in the Surrey, Langley area of British Columbia, Canada (near Vancouver). I had my first two kids in hospital and the third one was the most fun birth yet – it was a homebirth. So for this one, I am of course, planning another homebirth. I’ve moved neighbourhoods since my last one, so I have to find another midwife. (You can read more about my first birth, and see the slideshow of my home birth at¬†Birth Stories

I thought today I’d provide you with some information about midwives in BC.

 

1. Midwives are covered by MSP in British Columbia

That’s right! I’m always shocked and horrified that people don’t know their options when it comes to midwives. They think they have to pay out-of-pocket. They think that they have to have a doctor.

Here are the facts in BC : there are three kinds of maternity care providers and they are all covered by MSP, which means it is free for you – Family Physicians who do maternity care, Midwives, and OBs.

2. If you have a midwife, you don’t need to have a doctor for your pregnancy

In some countries, midwives are like nurses. But in BC, midwives practice independently so if you have a midwife, you do not have to also see a doctor for your pregnancy.

If you have a high risk pregnancy, OBs are a great option for you. In fact, family physicians and midwives will refer or consult with OBs if any high risk situation occurs.  But, research shows, if you have a low-risk pregnancy, midwives are a great option for you. Midwives specialize in low-risk birth, so they have the kind of skills needed to help you have a natural birth, and yet are trained to deal with situations where more medical help is needed. OBs, specialize in high risk birth and are not skilled in helping moms have a natural birth. They resort to medical intervention much sooner than midwives would. As such, comparing all low-risk pregnancies, OBs have much higher cesarean, induction and instrumental delivery rate.

3. Midwives have much longer visits

Midwives are paid more than Family Physicians for each pregnancy mom they have, but less than OBs. This is because midwives spend 45 mins with each client at prenatal appointments as opposed to the 5 – 10 mins doctors spend. This is to build a relationship and cover more comprehensive information with women which includes, nutrition, wellness, informed decision making, choices in birth and so on.

4. Midwives are responsible for you and your baby up to 6 weeks postpartum

Midwives provide continuity of care through the whole pregnancy, birth and up to 6 weeks postpartum.

5. To find a complete list of midwives in your area of BC

Go to BC College of Midwives

Or Midwives Association of BC

6. Register ASAP

I’d suggest calling several or all the midwifery offices in your area and registering as soon as you can. Midwives fill up fast. It’s ideal if you can register as soon as you find out you’re pregnant. If you would like to close the best midwife for you, register with a few so you can have a chance to interview them and decide which ones you like best.

If you’re further along and you have decided to switch from doctor care to midwifery care, do not despair. Although it can be hard to find a midwifery office with space, it is possible. I have had many doula clients decide mere weeks before they gave birth that they wanted to switch to midwifery care. They called a couple of midwives and found them to be full but after my encouragement, they called ALL the midwives in their area until they managed to find midwives with space. Go to one of the websites above and call ALL the midwives in your area. Don’t just give up after one or two.

 

For the Crunchy Granola Mammas :

 

Now having said that, if you are of the crunchy granola sort, like me, you wouldn’t just want to stop at choosing a midwife attended birth. You would want to carefully select a midwife who aligns with the kind of birth preferences you want. All registered midwives in BC practice within a range of guidelines. But there is a wide range of what some midwives are comfortable with. There has been some criticism that some midwives practice too much like doctors, jumping to medical intervention too soon before trying natural methods. They have been termed “medwives”.

There are also a few midwives who have chosen not to be registered with the college of midwives, and do not follow their guidelines. This is an interesting point, because before 1998, all the midwives were not registered with MSP. MSP only started including midwives in 1998. So a few of those midwives did not register because they felt registering would inhibit their ability to practice in the way they had previously been practicing. So the college of midwives now refers to them as “Lay Birth Attendants” ¬†instead of midwives. Why would they not want to be registered? Well, before the college was established, the midwives were trained in and regularly attended breech or twin births. Remember, in Europe, these are seen as variations of normal birth and not high risk situations. If the birth attendant is trained in how to properly attend breech or twin births, the risks are minimal. But in North America, breech and twin births have been considered too risky and are reason for automatic cesarean. ¬†Over time, the doctors and midwives skilled in such births have retired and the new ones left are not skilled in such births, which really does make it risky.

So if you would like to really increase your chances of having a gentle, natural birth or even a homebirth, but you don’t want to go with a birth attendant who is not covered by MSP, what do you do?

Like all advice about choosing your caregiver, you need to interview them and choose the one who matches your expectations. Don’t assume that just because they are midwives that they will all be totally crunchy granola. Here’s an example of what I mean by that : some women really want their pregnancies to be rushed along towards the end. They don’t mind having a stretch and sweep of the membranes in hopes starting labour earlier. But some women would be insulted at the mere question of whether they want a sweep. They want labour to start on its own. Some midwives routinely offer sweeps at 39 weeks and some don’t. So figure out what you want and find the care provider who matches.

Here are some questions you can ask :

1. Are you comfortable not doing any vaginal checks for dilation?

2. Are you comfortable attending a homebirth?

3. Have you attended water births before?

4. If the water breaks before contractions start, are you comfortable waiting without inducing as long as their are no internal checks and signs of infection?

5. Are you comfortable if a mom declines all or most prenatal screening tests?

6. Are  you comfortable waiting a long time before cutting the cord, if at all?

7. Are you comfortable with a natural third stage (placenta stage)?

 

Hope that helps you in choosing the best care provider for you and your pregnancy!

 

kaurina danu doula surrey langleyBTW, if you would like to know more about any of these questions and why they might be important, leave a comment below, send me and email at kaurina @ prenatal journey. ca or call me at 604 809 3288.

 

 

What the heck is Birth Trauma?!

Birth Trauma

Birth Trauma is a topic that has been weighing on my mind quite heavily the last couple of days. There have been ongoing protests outside BC Women’s Hospital in the last few months, and more are planned for different locations and hospitals around the Lower Mainland and Fraser Valley. The protests certainly caught my attention with this video on you tube Birth Rally at BC Women’s Hospital.

 

 

I know Birth Trauma and Post Traumatic Stress Disorder as a result of a birth experience exists, but this was the first time I was seeing people openly speaking out with terms like “Obstetric Violence” and actually naming the doctors who imposed unnecessary medical procedures on women without their consent. Seeing the signs just gives a glimpse of the tip of the iceberg. It’s hard to understand exactly what they mean until you take a closer look at what happened, why and how it causes the actual experience of Trauma. Then after that, the important question of, “What do you want to do about it?” needs to be asked.

One of the organisers of the events, Kalina Christoff, has also provided a detailed explanation of what exactly happened that caused her distress, what she did after to start a dialogue with hospital staff, and why she eventually felt like holding rallies was the only way left to create change for other women. You can read her story here : Vancouver Birth Tauma.

 

Untangling the mess

The term ‘Birth Trauma’ can refer to two things – physical damage to babies during birth; and the psychological damage to mothers during birth. Of course, there is also psychological damage to babies that can happen during birth but since that is harder to study, research in the area is relatively new and scarce. The content of this article will be about birth trauma to mothers. (I believe that mother-baby are not separate and what causes stress and harm to mothers, causes that to babies as well. And when mothers are treated well, babies are treated well. You can’t stress the mom out and say you’re doing it to take care of the baby. The mom’s stress will stress the baby out too.)

The general public has a perception of what Birth Trauma means. They usually assume birth is pretty painful and can be so unbearable that it can be traumatizing. So an epidural seems like a pretty good solution. Or they may think that women may feel traumatized only when their babies are injured or die during the birth process. While these events may happen, there is a much more multi-layered dynamic.

First of all it helps to understand the process of Labour and Birth as made up of two distinct processes

1. The natural course of events that would take place if there was no human intervention, and

2. The human intervention that takes place, usually in the form of medical procedures, some minor and some major, both of which can alter the course of the natural process itself.

 

What Causes Trauma?

While the natural process may be painful and difficult, that in itself does not cause the experience of trauma unless there is some cause for strong anxiety or fear. The more common cause for feeling traumatised is feeling the loss of power over your own body and situation when people do things to it that are outside your control. That is the cause of all trauma – Feeling Powerless over your own situation.

In other areas of life, you can see how certain types of situations can cause people to feel traumatised. Eg. Bullying, for example, where the victim feels like they have no power to prevent the bullying, War is another situation where people can feel traumatised, both the civilians who have no control over the events in their lives, and the soldiers who have to obey orders and do things that may not necessarily choose themselves.

 

So how can trauma happen in a birth situation?

Firstly, during labour and birth, the moms are in a vulnerable state. They are dependent on the care providers for helping them and their babies safely through the process to varying degrees. They also have some level of trust that their care providers will take care of them appropriately. Physically, they are vulnerable because they are in pain, half-dressed and may be exhausted and not thinking straight.

While most of the time, care providers are motivated by moms and babies best well-being, the fact is that they are also human. Just because we, as a society are trained to believe that we should always trust doctors, doesn’t mean that every doctor will never abuse his/her power. They are human. It would be ridiculous to think that everything a doctor does is always for the safety of moms and babies in birth. It’s not unreasonable to realise that there are other factors that effect decisions doctors, nurses and midwives make in labour. For example, scheduling, time, other patients, being tired, not wanting to do extra work, differing payment amounts for various procedures, peer pressure, lacking in experience or knowledge about certain situations, and as Kalina experienced, needing to train student doctors, nurses and midwives.

This leads to a heck of a lot of medical procedures done that kinda, maybe needed to be done, but probably not. Things are done to speed things up, make extra money, train students, get it over with so they can go home, go to sleep or go on to the next patient. The thing is, nobody is going to come right out and say that. They say things like, “The baby could be in danger,” “The baby’s heart rate is not looking good,” “It’s best for you and your baby,” and so on. Most mothers and fathers would not have the background knowledge to know the difference between a real problem, and a fudged one. They might happily agree to any procedure thinking it was saving their baby’s life. That probably won’t lead to feeling traumatised unless the procedure directly or indirectly causes some unexpected damage or pain, and the mom realises later on that the procedure may not have been necessary.

Many times, the risks to procedures are not explained before they are done. This can eventually lead to women feeling like they have no control over their situation because they don’t know what could happen or what they are agreeing to. Agreeing to a membrane sweep, induction, forceps, c-section and many other things has unwanted risks, but women are not told about them before they are agree to it. Worse still, it is common for membrane sweeps to be done by some doctors at 38 or 39 weeks without even informing or asking the woman’s permission. Forceps of vacuum can be great if the baby’s life is clearly truly in danger, but in those iffy cases where maybe, sorta the baby may be starting to show signs of distress, are the risks of forceps greater than the risk of waiting and trying other methods? Forceps can hurt the baby as well as cause permanent damage to the moms pelvic floor resulting in incontinence. If the mom is saying no, and the doctor does it anyway, can you start to see why some women say the way they were treated in labour was a violation just like rape?

 

birth trauma

 

That’s what causes the feeling of trauma and powerlessness. That’s what causes post-traumatic stress disorder after birth and ¬†some cases of post-partum depression. It is estimated that 4% of women have post-traumatic stress disorder after birth. But birth is a funny thing in human experience –

1. It is one of the few things that only women do. Probably if men did it too, it would be handled a totally different way.

2. It is a private event behind closed doors so the birth is not in public awareness.

3. You may learn how to fix basic things in your car, how to do your own accounting, how buildings are made even though you are not a mechanic, accountant or engineer. But, even though every single person on earth is born, shockingly very few people learn any basic knowledge about birth. Most of what they know is from the media, which is saturated in complete misinformation. Because of this fact, the decision making power over decisions about your own body and baby in birth is often handed over to health care professionals. This is a huge amount of power.

4. Unlike war, which is associated with death, birth is associated with being a happy time with a new baby. It is extremely confusing for both moms and other people when the joy and love is totally mixed up with trauma and horror over the way they were treated.

So because birth is quite different than most things in human experience, the general public cannot even comprehend why some moms could have birth trauma. This is quite clear when you start to mention Homebirth. The most common response is, “Why would anyone want to give birth at home?” “To avoid the risk of having my decision making power over my own body and baby completely violated, duh! What else, would it be?”¬†

I have seen births with complications where the medical staff was awesome, focused and committed to honoring the mother’s wishes within the realm of safety. For example, there was a baby who was having a little trouble breathing and they figured it would be better to take her to the nursery. It was important to the mom to have a few precious moments to see and touch her daughter before she was taken away. The hospital staff totally respected the mom’s request and understood how important it was. They took a lot of care to explain and comfort the parents about everything that was happening with their baby in the nursery so that the parents would not be overcome with worry. It was very touching.

In other situations, however, I have seen medical staff get annoyed with moms’ reasonable requests and feel that they are unimportant. The attitude is that it doesn’t matter how moms feel. They should just be grateful to have a live baby.

The thing is this, there was a study done which showed women’s experience of birth was influenced most by the way they were treated by the people around them, not so much the length of labour, the amount of pain or even the outcome of the birth. Women can have extremely long, painful labours, and feel really good about them if their care providers and support people treated them with respect and dignity. Women can go through miscarriage and stillbirth, and even though that may be very upsetting, can feel soothed by care providers who treat them in a caring way and involve parents in making decisions. Women may have a short, straightforward labour and a healthy baby but feel terribly about their birth experience if care providers were brusque, demeaning or disrespectful to the moms.

As I am writing this, an article is published int he New England Journal of Medicine.¬†Court-Ordered Care – A Complication of Pregnancy to Avoid.¬†It highlights cases where mothers are forced by courts and doctors to undergo medical procedures supposedly for the health of their fetus. Now for the people who can’t see the stupidity and violation of that, I don’t know what else to say. But I know one thing, there is no one in the world who cares more about the safety of her baby than the mother herself. Mothers are not stupid. They are completely able to make decisions about what’s best for their babies and would do whatever they felt was necessary. The doctor doesn’t always know what’s best.

 

If you or someone you know feels like they have birth trauma, please read Kalina’s page¬†Recovery from Birth Tauma.¬†If you would like to talk to someone, you can call me at 604 809 3288, or email kaurina @ prenataljourney.ca.¬†

 

Kaurina Danu is a Birth Doula and Prenatal Class teacher is the Surrey / Langley area. She works to empower mothers who want to make informed decisions about their pregnancies, births and parenthood.

 

 

Community Birth Program in Surrey Memorial opens its doors

Community Birth Program in Surrey

A fantastic new program has opened in the Jim Pattison outpatient clinic at Surrey Memorial Hospital for expecting mothers in Surrey, Delta, White Rock and Langley. The Community Birth Program is modelled after the South Community Birth Program in Vancouver, BC.

Both the Vancouver and Surrey programs are based on the groundbreaking and innovative Collaborative Care¬†model where Physicians, Midwives, Nurses and Doulas work together as a team. Doulas are provided to clients at no charge because of funding from Fraser Health Authority. That means that even low-income women, immigrant women or women who have never even heard of Doulas can have one to support them through pregnancy, labour and post-partum. The women are thrilled to bits to have someone give them personalized attention, in their own homes, and help them navigate the new territory of parenthood, especially if it’s also in a new country. (If you’re not sure what a doula does, read my page¬†What is a Doula?)

Fraser Health decided to provide funding for this program because of the immense success the Vancouver program is having. Significantly lower c-section rates, shorter hospital stays and higher breastfeeding rates. These is all great news for mothers and babies, but also for the budget of the Medical Services Plan so it makes sense to fund doulas and midwifery/physician collaborative care if it’s going to save on the other end with reducing unnecessary medical ¬†procedures.

Normally, reducing the medical budget compromises patient safety, but for maternity care in particular, there’s lots of room for reducing unnecessary medical procedures while not compromising necessary ones. For example, the World Health Organization suggests that the optimal C-section rate is probably around 15%. Less than that and women who really need it, may not be getting it, which is often the case in impoverished countries. But more than 15% and probably too many women are having cesareans that may not always be necessary.

To find out what the cesarean rate is in the hospitals near you in BC, go to¬†British Columbia Cesarean Rates. For example, Surrey Memorial Hospital has a cesarean rate of ¬†28.65%. So there’s room for reduction. While a small number of mother’s would rather have a cesarean, the vast majority would rather avoid one. So reducing rates would benefit moms as well as reduce costs. Pioneering programs, such as the Community Birth Program and many others that are effective at reducing intervention rates without compromising safety are important for helping maternity care providers as a whole understand how to effectively reduce rates.¬†

I’m really glad the Surrey Community Birth program has finally opened after years of preparation. It’s going to be a really positive direction for expecting moms in Surrey and the Fraser Valley. While maternity services in BC are already so good, ¬†and has continued to improve over the past years, there is always room for improvement.¬†

What I would like to see is good quality prenatal education that is available to ALL first-time moms – that effectively teaches pregnancy nutrition, making informed choices and real labour coping strategies. (I say “effective” and “real” because obviously, I have my opinions about how ineffective and unrealistic some prenatal classes are in regards to those topics)

Choosing an appropriate caregiver for pregnancy is one of the most important decisions women make that effects the path their birth will take. I always teach in my prenatal classes how to figure out if your caregiver matches the kind of birth you want. But by the time they come to my classes, their already in their third trimester. It would be great if women got more information about caregiver choices early on (like before they even get pregnant, or at least in early pregnancy). When women go to their doctors for the first pregnancy test, what I would really like is for those doctors to provide a handout about the three kinds of maternity care providers in BC РFamily Physicians and Midwives for low-risk pregnancies and Obstetricians for high-risk pregnancies. 

I would also like every pregnant woman to be informed by her initial doctor about what a doula is and how a doula can help her in labour and delivery. It is up to the woman to choose if she wants one or not, but I believe every woman should at least get the information that such support exists and is proven to be helpful. There have been numerous scientific studies which prove the effectiveness of doula support at reducing unnecessary medical procedures while increasing maternal satisfaction and breastfeeding rates. If a doula were a drug, it would be unethical for doctors to not recommend them. But doulas are not a drug, and are not at the moment funded by the Medical Services Plan, so expecting families hire a doula privately. Maybe someday there will be MSP funded doulas available to all women. But for now, there are three options:

1. Find a volunteer doula. The BC Doulas Association has a list of newer doulas willing to volunteer their services. Give them a call. In Surrey, you may also be able to find a volunteer doula through the Healthiest Babies Possible Program.

2. Interview a few doulas in your area and ask if they are flexible with their rates or if they have payment plans. I am very flexible with my rates because I know not everyone can afford them but I am passionate about providing support to women who want it, and lots of doulas feel the same way.

3. Register with the South Community Birth Program if you live in Vancouver or the Community Birth Program if you live in Delta, Surrey or Langley to get access to midwifery care, physician care and doula support.

If you are expecting and would like to register with the Community Birth Program go to Fraser Health РCommunity Birth Program for more information. If you would like to BECOME  a doula with them, also contact them.

 

 

How to know when Vaginal Exams in Pregnancy and Labour are useful and when they are harmful?

Vaginal Exams ¬†are commonly done in labour by nurses, doctors and midwives to find out how dilated the labouring mom’s cervix is. Other terms that refer to the same procedure are¬†VE’s,¬†Internal Exams or¬†Pelvic Exams.¬†It is basically putting two fingers in the vagina all the way up to the cervix to feel :

1. How DILATED (open) the cervix is

2. How soft and short the cervix is (EFFACED)

3. Which direction the cervix is facing – POSTERIOR (to the back) or ANTERIOR (to the front, when labour progresses)

4. Where the baby’s head is in relation tot he pelvic bones (STATION)

5. And what position the baby’s head is facing.

While this can be a very useful procedure to find out very useful information, women also need to understand the full picture.

First of all, the damn thing hurts. It ranges from slightly uncomfortable to downright excruciating. Now remember, in nature female animals and humans don’t regularly go around sticking things up their cervix to cause even more pain and irritation when doing one of the most difficult and intense jobs in their lives – giving birth.

Secondly, it is not an exact science. It is not as if they are putting a ruler in down there. They’re just feeling around and making an estimate with their fingers and their experience.

Thirdly, having too many done can introduce germs and cause an infection, especially if several are done after the water has broken. In general, VE’s should be kept to a minimum and used wisely, but after the water has broken, this guideline should be followed even more strictly. I have seen some births where The rupture of membranes happened days before birth (called premature rupture of membranes), but there was no infection because they were extremely careful to avoid internal exams and instead assess progress by external signs. And I have seen births where the rupture of membranes happened normally at the start of labour * but an unnecessary number of pelvic exams were done, only to cause infections in the mom so that they had to have cesareans.

* Note¬†: Most labours start with contractions and the water breaks towards the end of labour (around transition which is between 8 – 10cm dilation). Only 20% of labour start with the water breaking and then contractions follow soon after. If contractions don’t start within 12 hours of the water breaking, it is called Premature Rupture of Membranes (PROM).¬†

Be wary of having students nurses, doctors or midwives at your labour. They need to learn how to do VE’s effectively, so they do one, then the mentor does one to make sure they’re estimate is right. Then when there is a shift change, the new person might want to do another one. All of this is unnecessary and simply risky once the water has broken.

Some caregivers do internal exams towards the end of pregnancy because they want to guestimate how soon you’re labour will start. Some caregivers don’t do any internals before labour because they¬†don’t see any point in it. They figure labour will start when it starts. There are some changes that take place before labour. The thing is, there is no way of knowing when labour will start because the changes can take place, but then no action may happen for weeks, or no changes may happen and then in a very short time, everything can happen and labour can be quick.

About.com provides a brilliant article in their Pregnancy and Childbirth called The Myth of Vaginal Exams. 

Labor is not simply about a cervix that has¬†dilated, softened or anything else. A woman can be very dilated and¬†not¬†have her baby before herdue date¬†or even near her¬†due date. I’ve personally had women who were 6 centimeters dilated for weeks. Then there is the sad woman who calls me to say that her cervix is high and tight, she’s been told that this baby isn’t coming for awhile, only to be at her side as she gives birth within 24 hours. Vaginal exams are just not good predictors of when labor will start.

Some practitioners routinely do what is called stripping the membranes, which simply separates the bag of waters from the cervix. The thought behind this is that it will stimulate the production of prostaglandins to help labor begin and irritate the cervix causing it to contract. This has not been shown to be effective for everyone and does have the aforementioned risks.

So another reason some caregivers do weekly pelvic exams from about 37 weeks onwards is, if the cervix is slightly dilated enough to fit a finger in, they might try separating the amniotic sac from the uterus to try to hasten the start of labour. Some caregivers ask for permission before doing this, but some don’t even inform the women about what they are doing. So if you do not want his done, make sure you discuss it before allowing a pelvic exam in pregnancy. A lot of women get fed up with being pregnant and want this procedure done in hopes of speeding up the start of labour. But not all women want to do that. Know what you want and let your caregiver know what you want.

Fourthly, the results of a VE can be very discouraging if they aren’t what you expect. A woman who is in intense labour with contractions coming one on top of the other may be feeling that she’s in transition, yet have a VE say she’s only 6cm. This can be discouraging. The thing is, she may actually progress very quickly to 10. Where you are now has no relationship whatsoever with how fast you are going.

The fifth thing to consider will¬†help you determine when a pelvic exam might be useful and when it might be useless or harmful –¬†Will the information from the exam help us make a decision about the course of action ?

A lot of vaginal exams are done just for the heck of it to “assess progress”. Most of the time this is unnecessary and leads to unnecessary cesareans. Sometimes there may be no dilation for hours. There can be several reasons for this :

  • The baby might be rotating into a better position to fit through the pelvis. To understand how the baby’s rotation can help it fit, watch my video at¬†Understanding Optimal Fetal Positioning.
  • The mom might be feeling anxious or stressed, which can inhibit labour from progressing. To understand how emotions can effect labour,¬†Read my article.
  • Or there may be a genuine problem that cannot be solved except with medical intervention.
So the question to ask your caregiver if they are suggesting an exam that you are unsure about is, “What will you find out from the exam and what might you do based on what you find out?”

Usually two basic VE’s are done in labour, although sometimes even these are not necessary. One is when you get to the hospital, or if you are having a homebirth, when the midwife gets to your house. They usually do a VE to check if you are in active labour (4cm or more). Before active labour, the hospital will send you home, and the midwife will go home. Early labour can take hours and there is no point of being in the hospital before then unless there is some medical problem. If you are past 4cm, they will get you a room in the hospital, or the homebirth midwife might call the second midwife to get ready to come.

The second VE may be done when you feel an overwhelming urge to push. They may want to make sure there is no cervical lip left before you start pushing. In both these cases, action will be taken based on the results of the VE.

Other times that a VE may be useful are when a mom is really asking for medical pain relief. The amount of dilation will determine what kind of pain relief (epidural or morphine) may be appropriate or whether labour is close to the end and maybe no pain relief is necessary.

The thing is, some VE’s are done just for the sake of charting purposes. There is a ridiculous theory that dilation ought to be at least one cm every 2 hours. It doesn’t take a rocket scientist to figure out that different people do things at different rates and that’s ok. It doesn’t mean anything is wrong.

The important thing is to limit the number of VE’s done by figuring out if the information they provide will help you and your caregiver make decisions about what to do next. Don’t take the results of VE’s to seriously. Don’t get discouraged if it’s not what you expect. (I know that’s easier said than done.) And try to have only one person do the VE’s in labour instead of different people and different opinions.

 

To find out more about prenatal education, natural birth information or doula support in labour in Surrey or Langley BC email kaurina @ prenataljourney.ca or call 604 809 3288.

 

Working on writing book about Birth

Anyone who knows me, knows that I’ve been working on writing a book about birth for a couple of years now. Anyone who’s ever written a book, knows that writing a book is a tricky process.

For me, the trickiest bit has been deciding on the angle to write it from. I know what specific topics I’m passionate about. I’m just trying to figure out how all the theses I have evolved over the years can fit together like nice a big puzzle. And how it’s going to have the most impact on improving the culture of birth in the world.

So far I have come up with an outline I’m pretty proud of. Here goes :

 

 

The Epistemology of Woman-Centred Maternity Care :

Bridging The Gap Between Natural and Medical Models of Birth

 

 

In the book I would like to offer solutions to a problem as I see it. While so many advancements have been made in the field of maternity care, and we now know more than ever before, the outline of the problem is this :

1.The statistical rates of mortality, morbidity and complications are still higher than they need to be in much of the world, as evidenced by considerably lower rates in a few places in the world. While poverty is a factor that contributes to much of those statistics, and is a factor that is beyond the scope of this book to address, there are other easier to address factors besides poverty that can be reduced, and I shall highlight some of them. The natural process of birth and medical management of birth exists in a delicate balance. Many experts point to evidence that overuse of medical intervention in birth has tipped the scales of safety towards less safe outcomes. While benefiting those who need it, it has been suggested that its over reliance and use on those who don’t need it has in fact, CAUSED some complications and poor outcomes for mothers and babies.

2.Beyond the statistics, are many women and children who are physically and emotionally damaged in small and large ways by the management of their births.

3. In an effort to avoid this overuse of medical techniques in birth, a small but growing percentage of the population of North America has turned instead to avoiding the hospital altogether as they do not feel safe giving birth there. There is also an alternative philosophy to the medical management model, which is woman-centred care. The field of midwifery is generally responsible for the knowledge produced on woman-centred maternity care, although many individual doctors practice this way, and not all midwives practice woman-centred care. Woman-centred care is the topic I would like to delve more deeply into in this book so that everyone can get a clearer picture of what that means, what it entails in real life practice and how it can make significant differences in outcomes as well as people’s real lives.
So while there is a body of knowledge that comes out of the experience of midwives and the experience of homebirth, there is a tremendous gap between that body of knowledge and mainstream medical maternity care.

4. Furthermore, the body of knowledge that is still missing from both these perspectives of midwives and medical professionals is the epistemology that can come from the experience of the women doing the birthing themselves. I would like to suggest that by piecing together the knowledge from individual women’s experiences and formulating a collective position, it would be possible to bring maternity care a a whole new standard, as well as bridge the gap between the medical and natural birth worlds.

Everything in our world is always improving and evolving. There is no reason why the culture of human birth should not. I strongly believe, however, that the improvements will not come from more technology, but from a deeper understanding into the human psyche of labouring women themselves. It is the inner mental and emotional experience of labour that can offer the clues to understanding the delicate hormonal balance that controls the normal process of birth. While medical advancements have made it safer than ever before to use medical interventions such as epidurals and cesareans in birth, they will probably always be less safe than the non-man-made process of birth. Just as infant formula can be made as close as possible to breastmilk, it will always remain a far cry because it is impossible to create the living enzymes, antibodies and ever changing micronutrients in breastmilk. The long term effects of medical interventions into the process of birth is far greater than anyone can comprehend. I would like to suggest, despite all our advancements and 100,000 years of human history, shockingly little is understood about the normal, uninterrupted process by which human beings come into the world. I would like to bring more understanding of this into mainstream knowing. It is my hope that by fitting the missing pieces together, we can have a future world where human beings start off their lives with less trauma and more love because it is this that makes us human.

 

I’m putting it out there for anyone reading this : If you would like to add your contribution to the book, please let me know. You can email me at kaurina at prenataljourney.ca or call 1 – 604 809 3288.

I am looking for : childbirth experts – midwives, doctors, nurses and doulas, as well as, moms who would like to add their own experiences.

I know your time is valuable, so I would make it as easier as possible for you to add your input. If you prefer to writing, you can write me an email on the aspect you would like to contribute. If you would like to do an interview instead, I can set up a convenient time for you to do an interview.

 

I appreciate your time and wisdom.

Rethinking the medical care provided to Premies

Every time I look at premature babies isolated in incubators, my mind screams out, “Let the mom hold it!!!” For years I wondered if I was the only person who felt that way. I know premies need to be kept warm, away from germs and with little stimulation, but separating them from their moms seems counterproductive.

Then I learnt about the options with cutting the umbilical cord – immediate cutting or letting the blood continue to flow from the placenta to the baby until it stops pulsing by itself. The common medical practice in many places is to cut the cord immediately, especially when baby needs medical help. The irony is that if a baby is not breathing, or is premature and needs medical help, they are more in need of the extra flow of blood, oxygen and nutrients from the placenta, and yet these are the ones who are more often separated from the source of that which can help them.

It was heartwarming to read of the recent story in the National newspaper in New Zealand, of a very tiny premie, who was born in an ambulance before the mom and midwife could reach the hospital. Because they were not in a hospital, they had to resort to basic techniques to help the baby. Two of the things they did was to leave the cord intact to allow blood and oxygen to continue flowing, and put it on its mothers chest. The baby did surprisingly well.

The baby girl was born at 10.50am weighing just 907grams, but she was pink and breathing by herself.

“I was so relieved and impressed that this tiny little thing was fighting so hard to breathe.” While midwife, Ras, was monitoring the baby’s oxygen and caring for her mother, James and Reesink were organising a helicopter with a paediatric team from Whangarei.

Ras, who specialises in natural birth, says: “In an emergency like this, with no immediate hospital back-up, you go back to the basics: all babies need air (oxygen), warmth, food and love. On mother’s chest, close to her heart, connected to the placenta and oxygen near her mouth ‚Äď this was the best we could offer her for the first hour. We made a little hat of Gladwrap and a Gladwrap blanket over her body so she wouldn’t lose heat or fluids through her very thin skin.

“Babies who are born this early can’t suck or swallow so we could only hope the paediatrician would come soon to put a drip up with glucose and the necessary medication.” The ambulance moved to the Kerikeri Domain to be ready for the emergency helicopter. Every time the mother moved, the baby made little noises like a bird, Ras says.

The temperature in the ambulance was up to about 30 degrees C when the paediatric team, including a doctor and a specialised nurse, arrived by helicopter from Whangarei.

“They were surprised that little Cynthia Jane was still pink and breathing and her blood sugar level was pretty good.¬†It was an amazing team effort with five people in an ambulance on the Kerikeri Domain, fighting for the life of such a small baby, who even in a tertiary hospital might not survive.”

You can read the full story at http://www.stuff.co.nz/national/health/6109172/Tiny-babys-dramatic-delivery.

 

Could it be that the baby did so well because of the basic things the caregivers did, which would not have been done had it been born in a hospital with more high tech stuff? Of course this is just one story. One story is not proof. But it does beg the question. I had a friend whose premie baby died despite all medical efforts to save him. Looking at the details of his particular situation, I can’t help but wonder if he died because of all the medical efforts to save him. There was one point in which they could have waited to see, instead of intervening. But we will never know. The doctors were just trying to do their best with what they knew.

One of the most painful memory my friend had was that in the months he was in the incubator, she did not touch him or hold him. She just wished she could have held him. It would seem to me that, as much as the mom has an overwhelming need to hold her baby, the baby has an overwhelming need to be held. I was thrilled to come across clear and evidence-based information about Kangaroo care for premies, and I imagine, lots of it is useful for sick babies and normal babies as well.

Dr Nils Bergman and his wife, Jill Bergman, from South Africa, have worked on the figuring out the best care for premies. Their website,  http://www.kangaroomothercare.com/ , features an all-rounded approach to this insanely stressful time for parents of premies, the medical team caring for them, and the best health practices for the premies themselves. Their video on you tube describes the book written especially for parents to understand the medical stuff so they can feel empowered to make decisions together with the medical team. http://www.youtube.com/watch?v=_O0w8Lhekb0

It is my hope that medical care for premies and sick babies continue to improve and continue to take into account the emotional as well as physical needs of the babies and their parents. Until then, I hope that parents who have a premie can use this information to help them negotiate and discuss the care plan for their babies with the doctors and nurses, and also get support for their emotional health needs.

 

If you need to talk to someone about your emotional health surrounding any pregnancy, birth or parenting issue, now or in the past, you may call Kaurina at 1 – 604 809 3288.

 

 

 

Oh Baby Magazine article on Doulas

Just another of the many articles and videos on how useful it is to have a doula at your birth.

“Looking for a way to decrease the length of your labour, reduce your need for pain medication, decrease your chances of needing a forceps delivery or a Caesarean, and leave you feeling satisfied about your birth experience? What you need is a doula‚ÄĒthe birthing world‚Äôs equivalent of a fairy godmother.

Think I‚Äôm exaggerating? Consider the evidence for yourself. There‚Äôs a growing body of research proving that doulas (experienced non-medical female companions who provide continuous labour support) can help to improve the birth and postpartum outcomes for both mother and baby…“

To read the rest of the article you can go to Why Doulas are a Mom`s Best Friend at Oh Baby Magazine.

doulas

The question is not, “Will it be worthwhile to hire a doula?“

The question is, “Why don`t more women hire a doula?“

Doulas are a relatively new and growing profession, although the roots of it stretch back to the beginning of humankind. Since women have been giving birth, other women have attended to the mom in labor, providing physical and emotional support so that she can get through labor feeling calmer. In the past, the role of the midwife and the doula was the same.

Now the differences in the roles are more clearly defined, although there is some overlap. Midwives are responsible for medical tasks and for catching the baby, while doulas focus on the emotional and comfort needs of the mom. Also they provide continuous labor support, from the beginning of active labor in the home through to birth and breastfeeding. Nurses, midwives and doctors may have other moms to attend to and have other technical tasks to do.

The research by Klaus and Kennel reveals something very interesting – that women have easier labors when someone is giving them undivided attention. The thing is, this is difficult for people to wrap their minds around. It is difficult for most people to understand how a doula can help them in labor. Those who do, are glad they did hire a doula and can`t imagine how other women manage through without one. There is a quote that says, “If a doula were a drug, it would be unethical not to use one.“ I think in the future, the majority of women who want a natural birth will automatically hire a doula.

Even in the animal world, there are doulas. Most animals like to birth in complete privacy, but some social animals don`t labor alone. They need other females around them. Dolphin females swim around the dolphin mom in labor, nuzzling her with their noses. Elephants as well, which are highly intelligent and social animals need other females around, stroking them with their noses.

There was an elephant in a zoo who was in labor. The zookeepers moved her to another enclosure because they thought the other elephants would disturb her or the baby. What they found was that when she was separated, she went into distress, stomping around and wailing, banging herself on the fence. The zookeepers called another zoo that had experience with elephant birth. They said to put the elephant back with the other females. When she went back, her elephant doula friends stroked her with their noses and she immediately calmed down and had her baby smoothly.

Humans can learn from other social mammals because we have forgotten how the natural process of birth works.

Where I am, here in Surrey, BC, I hear some of the more common reasons women don`t hire a doula, even though they want a natural birth. One is that they think it will be too expensive. They`re usually shocked when they find out how reasonable rates are considering the time and benefit. Doulas are committed to helping all moms who want a doula. We don`t believe finances should be a reason not to have one. Some doulas, especially newer ones, even volunteer their services for moms who cannot afford even a basic fee. To find volunteer doulas go to BC Doula Services Association.

Another reason is that they feel that they have enough support because they either have a midwife, or have family support. Those are awesome, however, the role of a doula is quite different. I know from my own experience at the birth of my first child, the midwife is not going to be with you all through labor. She has other things to attend to, and is responsible for all the medical tasks.

Family or friends are great supports, but they don`t have the training, and the experience of learning from hundreds of other births what to do in different situations. The doula does not replace husbands or family, because they are the ones you have a relationship with, but they bring so much more knowledge and skills. Doulas involve the dad`s and other family members and teach them comfort measures that help the mom. Dad`s are always glad to have a doula there so the pressure to know and do everything is taken off him.

Do you have a story or a question about doulas? If so, I`d love to hear your comments.

For more info about hiring a doula in Surrey, Langley or anywhere in the Lower Mainland, BC, call 604 809 3288 or email info@prenataljourney.ca

 

 

 

 

I didn’t know about midwives!

“I didn’t know about midwives!” I hear it all the time. I’m always surprised that most people, in particular, expecting couples, have no idea that having a midwife be their primary caregiver is even an option. Ok, I admit, before I had kids, I had no idea either. I thought midwives only existed in the middle ages. (I’ve come a long way since then)

So let’s set the record straight now : If you have a low-risk pregnancy, you can choose to have a midwife if you want.

Across the world, and in different provinces or states, the regulations and scope of practice of midwives (called Femme Sage in French) varies so check out the rules in your area. In some countries, like in Northern Europe, midwives are the primary caregivers for the majority of pregnant women and obstetricians mainly only manage high-risk pregnancies. In some countries, what they refer to as midwives are nurse-midwives who work in the hospitals and are not the primary caregiver.

Here in BC, Canada, midwives practice independently, meaning you don’t have to have a doctor if you have a midwife. The midwife handles all prenatal appointments, birth, and care up to 6 weeks post-partum. Before 1998, midwives were not part of the Medical Services Plan (MSP) so women choosing a midwife had to pay for their services themselves. In 1998, midwives organized under the College of Midwives of British Columbia, became included under MSP. So it is now free for women to have a midwife.

They are all highly trained to attend low-risk hospital births as well as home births. They are well-integrated with the rest of the medical system so they are able order medical tests, do basic medical procedures, refer to an obstetrician for a high-risk issue, handle problems at home births and transfer easily to a hospital if a need arises.

Most midwives are booked solid, so if you want to consider a midwife, try registering ASAP. Preferably as soon as you find out you are pregnant. Despite most people not knowing about them, they are very popular amongst those who do. One of the reasons is that their prenatal visits last 45 minutes so parents have a lot of time to ask questions, discuss things going on in their lives, and build a relationship. There are many things that affect the health of moms and babies, not just medical or physical things. Stress at work, financial issues, other kids the mom has, nutrition, relationships, fears, all impact your health. Women love having a midwife because they get enough time to discuss and resolve anything that may be affecting their life while they’re pregnant.

They may also choose a midwife because midwives tend to have more skills involved with the natural birth process, and tend to use less medical interventions. Of course there are also many doctors who are skilled at supporting natural birth and only use interventions when necessary. Generally speaking, midwives follow the Midwifery Model of Care.

Many women say, “I’d rather get an obstetrician because if anything happens they’ll know what to do.” That is a reasonable statement, but it may not be totally accurate. A lot of people have the paradigm that midwives know a little, and obstetricians know a lot. It is probably more accurate to think of it this way : midwives are experts in natural and normal birth. Obstetricians are experts in dealing with complications in birth. Both fields are extremely important. If a woman has a high-risk pregnancy, and obstetrician is the best option, but if she has a low-risk pregnancy, there is no evidence that an obstetrician is the best option. Although there are some obstetricians who really understand the dynamics of how to promote natural, normal birth, many obs tend to use more interventions.

Women with low-risk pregnancies actually have three choices – midwife, family physician who does maternity care, and obstetrician. In rural areas, the physician may be the only option. We are quite lucky here to have the best of both world, so to speak, because the system is so integrated. So in the case that anything were to happen, midwives and physicians are able to include an ob on the team.

Now you know your options but in the end it always comes down to, “What do you want and what is important to you?” If you haven’t read my last post on¬†Respecting the Mother’s Preferences for Birth you can read it. You know yourself. Is it important to you to have a natural birth as possible, or do you feel safer with an obstetrician. Do you want to interview a few physicians, obs, or midwives to see if they line up with topics that are important to you, or do you want to choose the first one you get. It’s all up to you.

Here are some links to Langley and Surrey midwives if you’d like to look into having a midwife for your birth :

Midwives in BC

Surrey –¬†Sage Midwifery

Panorama –¬†Village Health Midwifery

White Rock –¬†Crescent Moon Midwifery

Walnut Grove –¬†Grove Midwifery, ¬†Triton Midwifery

Willowbrook –¬†Family Health Clinic

 

What are thoughts on the subject? Add your comments below.

 

© copyright 2011 Kaurina Danu The Prenatal Journey

Review of One World Birth videos

September 1st was the launch of the new internet video channel One World Birth. I decided to take a look at some of the videos.

The videos are all short clips of interviews with various experts from Europe and America discussing their views on topics around birth.  There are some well known natural birth names РIna May Gaskin, Michel Odent, Sarah Buckley, Sheila Kitzinger and so on. It brings to awareness the polarity that sometimes exists between people who want to promote natural birth as much as possible, and people who want to promote medical intervention in birth as much as possible.

I would like to think that moms who really need medical intervention can get it, and moms who don’t really need it aren’t pressured into having it, whether cesarean, induction, pain meds, fetal monitoring, IV, episiotomy etc. But often the definition of “really needing medical intervention” is the area of debate. There are some situations in birth, although rare, where doctors or midwives all agree are serious problems which require medical intervention. There are some situations where all doctors and midwives agree no medical intervention at all. But the majority of situations in birth fall into the grey area. Different caregivers disagree on the course of action.

The videos on One World Birth begin to bring to light some of the problems in maternity care and the solutions. The Revolution in Birth is one particularly interesting video. I love what they say about how improving maternity and the way mothers and babies are cared for during this important transition in life, will improve society as a whole.

“The topic of birth should not just be a topic for doctors, midwives or pregnant women. It should be a topic for all those interested in the future of humanity.” ¬†– Michel Odent, MD

“Natural birth has become an endangered species. And we need to save it because the future physical, emotional, mental health and well-being of our culture depends on it.” ¬†– Sarah Buckley, GP

I also quite liked the section “60 Sec Experts” where 3 doulas only have 60 seconds to answer common questions about childbirth –

How painful is childbirth?

How to relax during birth?

How do I know if breastfeeding is working properly?

Is a doula a midwife?

What’s the difference between braxton hicks and contractions?

Is it better to tear or be cut?

 

I’m looking forward to more videos on One World Birth. It will be interesting to see the development of the topics as the film makers travel around the world.

 

 

© copyright 2011 Kaurina Danu The Prenatal Journey