Summer 2017 Group Prenatal Classes for Surrey Langley have now been scheduled!
These classes are for expecting moms due August or September. Groups are kept small to ensure parents get their unique questions and concerns addressed. Prenatal Journey’s prenatal classes are specially designed for people who would prefer to have as natural a birth as possible.
The classes will empower you to understand the physical and emotional journey of childbirth and what effective strategies real life women use to get through labour and have positive birth experience. You will also learn how to make informed decisions about your healthcare and that of your child.
Moms often start out feeling nervous about their ability to cope with labour, but end up feeling confident in themselves, their partners, and looking forward to meeting their babies and the journey that brings them.
Live in Surrey or Langley and Expecting a Baby Soon? Thinking about having Doula Support for your Birth?
Prenatal Journey currently has space for one more client due Jan 2017, and one more due Feb 2017. If you’re due in March or later, there is still space. I provide Birth Doula Support to moms-to-be in Surrey, Langley, Delta, Vancouver and Abbotsford.
Having a doula is a great idea if you would like to have more support through your pregnancy, birth and postpartum time. It’s especially helpful if you want to have your best chance at having a natural birth. Doulas provide non-medical physical, emotional and informational support so that moms can have an easier time in labour and have an empowering, positive birth experience. Evidence proves that having a Doula reduces the need for pain meds like epidurals or narcotics, and also reduces the need for inductions and cesareans. They also increase successful breastfeeding rates, reduce postpartum depression, and make sure moms and babies start their new phase of life feeling supported, positive and capable.
At births, I often help moms cope with labour with specific techniques and tools – counterpressure, hip squeezes, massage, position changes, TENS machine, encouragement and so on. I also am a great listener, supporting moms through any emotional challenges they are dealing with in pregnancy, birth, or after their babies are born. Being there with moms right in labour and being available 24 hours a day by phone in pregnancy and postpartum to answer any questions, helps moms get the information they need to power them to make informed decisions about their well-being. Dads also LOVE having a doula to help out in labour. Dads are so important at births, and I always make sure I show dads how to effectively support their partners. Dads and doulas usually work as a team. Moms can’t have too much support in labour.
Prenatal Classes, and Birth Photography
Besides doula support, I also teach prenatal classes and provide birth photography. I offer private prenatal classes in Surrey, Langley, and surrounding areas. They are on your schedule and in the comfort of your own home. Group prenatal classes are in small groups and consist of two full Saturdays, or once a week for 8 weeks. Many clients also love having birth photography done to capture special memories of their child’s brith and the first moments of life.
If you’d like to register, call 604 809 3288 or email firstname.lastname@example.org
Here’s what a doula and prenatal class client has said,
I was determined to give my daughter Valentina a natural birth at home without the use of any pain medication. Thanks to Kaurina, I was able to physically, emotionally and mentally prepare myself to make this happen. Kaurina was very thorough and motivating during those important months of preparation, helping my husband and I shape the kind of birth that we wanted for our baby. It was through her inspiring talks that we truly shaped our home-birth plan, as she helped guide our thinking as well as presenting many options that had not occurred to us. Thanks to her we were more than prepared for the arrival of our daughter. Not only did she provide me with the support I needed, she provided my husband with extremely helpful tools, helping him become an integral part of the birthing process.
During labour, I was so deeply thankful to have Kaurina with me as my doula. She was calming and reassuring, providing me with excellent coaching, calming my mind and body, giving me the focus and direction I needed to bring Valentina into this world as calmly and quickly as naturally possible.
After the birth of Valentina, the world came into sharp focus. No matter how many nieces, nephews, or children of friends, nothing prepared us for the intimate feeling of caring for our own child. With this also came the fears of proper care, the immediacy of her needs, and the emotional roller coaster of the post-partum period. Kaurina was there for us in every way. She answered every phone call and question, as well as coming by to check on our health, well being, and techniques; such as showing me useful breastfeeding techniques, how to care for the umbilical cord, and the best way to approach a bath for a newborn.
All of this care made for a truly beautiful birth experience, as well as ensuring a positive post-partum period; Kaurina can be thanked for it all.
A TENS machine, or TENS unit, is a simple device that you can use in labour to reduce the sensation of pain, and so it can help you have a natural birth. TENS stands for Transcutaneous Electrical Nerve Stimulation. You place these sticky electrical pads on your skin, and it delivers tiny electrical stimulation to the nerves. It is used by physiotherapists for pain relief of various kinds – muscle aches, migraines, back ache, injuries, and pretty much any pain, whether accute or chronic. For decades now, it has also been used for labour pain.
How is a TENS machine used in labour?
The sticky pads are place on the back in early labour, or near the start of active labour. It takes an hour or two to build up in effectiveness. It works for natural pain relief using the Gateway Theory of Pain – the stimulus to the sensation nerves blocks out some of the pain nerves because the brain can only process a certain amount of stimulation from the nerves before it starts to block out some out. About 80% of moms in labour who use a TENS machine say it helped them reduce and cope with the pain.
There are several brands of TENS machines. The most common one used for labour is the Elle TENS machine which has a Boost button to increase and change the pulse during contractions.
Are there risks or side-effects?
There are no risks or side effects except that you obviously can’t use it in the shower or bath. It is also not recommended if mom has a pacemaker. It should also not be used on the abdomen during pregnancy. It should be placed on the back.
Because it can be an effective method of pain coping in labour, with no side effects, it makes an excellent tool to have if you want a natural birth.
How to get one in Surrey or Langley?
If you want to have a TENS unit for labour, you have to get it before hand. Hospitals do not have TENS units available, although it would be great if they did. You can either buy one or rent one, or if you have me as your doula, you will have access to mine. To find out about how doula support can help you click on Doula Support.
If you are in Surrey, Langley or surrounding areas, you can rent a TENS unit from me for up to 5 weeks. The fee is $90 and includes 2 sets of electrical sticky pads. You can call me at 604 809 3288 or email me at email@example.com.
If you would like to purchase your own so you can have it for more uses than labour, they are available in Vancouver at Natural Creation or the Facebook page.
Wow! It’s been over a year since my daughter was born and it’s been so much fun being with her. I’ve had such a blast and it’s been a really great experience watching how much my 3 older children just love her to bits. People had asked me if it was hard having the big gap (the youngest is 8 years older than the baby) and then going back to looking after a baby again, but no, it’s been such a pleasure. I feel way more confident as a mum now than I did before, and watching the older kids interact with the baby has been such a gift.
So now that the baby is a toddler, I’m ready to start accepting clients for Birth Doula Support, as well as, Prenatal Classes.
Doula Support :
I have space for expecting parents who are due April 2016 or later and would like doula support for their birth. I only have a few spots available each month and some months are filling up fast, so call 604 809 3288 now to reserve your spot.
I provide doula support for births in Delta, Surrey, Langley, Abbotsford and other parts of the Lower Mainland.
If you’re not sure if doula support is right for you, or you’re not sure what it even is, feel free to drop me a line and ask. Or go to What Is A Doula? If you wanna know what other moms are saying about doula support click here.
Prenatal Classes :
If you would like Prenatal Classes, I am offering private prenatal classes right now for individual couples in the convenience of their own homes.
Group Prenatal Classes will be available starting in June 2016, so if you are due in the summer or later, group prenatal classes would be perfect for you.
Group classes will be held in Clayton Heights on the Surrey Langley border, and private prenatal classes are in your own home. I travel anywhere in Delta, Surrey, Langley, Abbotsford, New Westminster and so on. Parents-to-be who would prefer to have a natural birth, really like my classes because they are geared especially to teaching skills to increase your chances of having a natural birth.
Private classes are available for both first-time parents and parents who already have child but want to take a Refresher course. Parents who take the Refresher course tend to be people who have had a previous cesarean and want to have a VBAC this time (Vaginal Birth After Cesarean), or moms who have a new partner with the next pregnancy and would like their partners to learn how to support them in labour.
Life Coaching for Moms – Helping moms solve their problems whether it’s career-life balance, relationships, financial, parenting, self-confidence and so on. Find out more at Free Chaos to Calm Session.
Life Coaching for Moms is by phone or Skype so it’s actually available anywhere in the world and not just the Lower Mainland, BC, Canada.
If you have any questions, you can contact me at 604 809 3288, or email me at kaurina @ prenatal journey .ca
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.
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.
Once 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.
Eventually, 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.” 🙂
(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.
I 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.
We 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. 🙂
So I have some exciting news! On Mother’s Day 2014, I found out I’m expecting my fourth child.
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
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!
BTW, 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.
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?
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.
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 – Family 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:
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 – Community Birth Program for more information. If you would like to BECOME a doula with them, also contact them.
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.
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 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.
The prices for Prenatal Classes and Doula Support will be going up as of Aug 15th 2012, so if you would like to get the current prices, book now.
Weekend prenatal classes are in the Surrey / Langley area of BC, Canada. Private prenatal classes for first-time parents as well as experienced parents are anywhere in the Lower Mainland from Vancouver to Abbotsford.
Doula Support now includes complementary Birth Photography.
For more information about The Prenatal Journey’s prenatal class philosophy and content go to Prenatal Classes.
For info on schedules and current class pricing, go to Schedules.