sábado, 28 de noviembre de 2009

Why I love Conferences

I have a very strange job. I honestly believe that women who are totally out of control and submerged in an incredibly painful experience are the funnest people to hang out with. I admit, I am addicted to crowning and I love watching women's faces when the placenta comes out. I am happy to leave my warm bed with a gorgeous man in it at 3.00am to go hold a woman who is throwing up.

I spend countless hours discussing pain, body fluids, bone mechanics and change. I spend a lot of my free time reading more books about how to approach these. I love listening to women making decisions and watching men's eyes get bigger than the room as their watch their women stretch and stretch and stretch.

My hours are really strange, I spend most weekends at a birth and I rarely take vacation. I am an average homebirth midwife. And once or twice a year I am lucky enough to join 3 or 4 hundred other women that honestly believe it is normal to live like this. Not just normal, thrilling amazing and orgasmic. We love our lives.

I remember when this clicked in my mind, I was standing in a hall with about 500 other midwives singing our hearts out, having spent all night talking about births, and positions and juicy, fluid filled moments. We were dancing through a red tube that was supposed to represent a very large yoni. It is my sacred, special time where I'm not an expert, where I don't have to explain why homebirth is actually SAFER than other kinds of birth, where women don't look at me and say, "but I'm really scared of some fantasy I have created in my mind". It is a time where I am honored and my tradition is honored. Where I can look around and thing, wow, we all do the same thing. This is incredible. It is a time to know that I'm not the only nutter who is addicted to crowning, there are actually thousands of us across the world and we are watching a LOT of babies crown every day.

I love conferences because they are my pilgrimage. They are where I understand deeply that I am part of something huge that is changing the world, making it safer and more peaceful. One birth at a Time. All over the World.

martes, 24 de noviembre de 2009

viernes, 20 de noviembre de 2009

Babies experience of Birth

I just finished reading Wendy Ann McCarty's book, "Welcoming Consciousness, Supporting Babies Wholeness from the Beginning of Life". I first heard her speak at a conference three years ago and she deeply moved my approach to birth and babies.

The book stands for the experience of the baby. Please note as you read this that I am clear about the fact that the baby emerges from the mother and that supporting a healthy mother is essential to babies well being.

At the end of the book she describes specific therapy cases where she has worked with babies who have had difficult gestation, birth and immediate postpartum experiences. She describes how she listens to the baby react and re-enact their experiences. As I read this I think about the fact that most births completely disregard the woman's experience, thus clearly there is absolutely no context for understanding the baby's experience.

The way I see it, your birth, which is recorded in your implicit memory is your introduction to your parents, your world and your country. We are now aware of the long term impact of this on babies mental and physical health. I used to teach a workshop where someone was asked to leave the room and told to come back in. Upon entry we would treat them the way babies are taught in traditional Mexican hospitals. As beings with no feelings, no capacity and on the brink of death. We would rub them, aspirate their mouths with a bulb syringe, move them from place to place measuring body parts, etc. It was a traumatic experience for all involved. We would then ask the person to describe how they wanted to be greeted upon entry and we would participate in enacting this for them.

We often ask parents in our practice, how do you think your baby wants to be received? This is a very useful question for moving beyond the fear of "Will the baby actually breathe f there is no doctor to stimulate that?".

I challenge you then to ask yourself, as a parent or as a midwife, if I were to be born, what would be really important to me, and what would not? What would make me feel welcome and safe? What would help me breathe and encourage me to want to stay in this place?

martes, 17 de noviembre de 2009

Deliver me from Pain

This is a MUST READ for anyone interested in Birthwork and the history of obstetrics. The book is broken down into questions, which I thought was a brilliant way of indulging into the issue of anesthesia in obstetrics. The first chapter is called: The Question of Necessity. This chapter maps out how anesthesia became an issue within obstetrics to begin with. What is most fascinating about this story is that although women have always stated that first stage (dilation), particularly late first stage (8 to 10 cms) as being the most painful, because of the vocal and physical intensity of second stage (pushing) the medical community (new to birth!) got the impression that second stage was the moment of worst pain. So doctors started to anesthetize during pushing. Now thats going to make those forceps pretty handy!

What is fascinating about this chapter is how anesthesia became necessary and considered liberating, necessary or appropriate (depending on the historical times and jargon). From then on, pain became inappropriate in labor and unnecessary for birth; which brings us to where we are now- grand-daughters of women who were delivered under twilight sleep, daughters of women who "can't remember" how it was because they were over-dosed with scopolamine interlaced with their spinal and ourselves discussing with our obstetrician at what point in labor should we get our epidural.

What is interesting for me, as someone who listens and tries to answer women's questions, is: how do we talk about birth after not feeling it for 150 years? How do we tell women that natural birth at home, where we are free to FEEL ALL the pain and "become empowered" by it is better?? Please!!! I almost feel absurd.

What this book illuminated for me is that, after 150 years of first explaining to women to labor pain is SO unbearable that high doses of dangerous drugs, limp, breathless babies, detached families are not only necessary, but beneficial, and secondly eliminating therefore the collective memory of what labor pain feels like, but also our collective capacity to deal with labor pain. It is no wonder that grandmothers look at me and say- "I can't bear to see her in all this pain".

Funny thing is, I can. And so can she.

Homebirth Obstetriciians?

An interesting discussion emerged from the AMAYAL Humanized Birth Conference carried out conference in October 2009 in Monterrey, Mexico. It is important to note that Monterrey Mexico holds one of the highest cesarean rates in the world. In this context, Nacer Renacer, as the perinatal education branch of Amayal works through prenatal education and support to inform and educate women on natural birth. They are working with a male obstetrician who attends homebirths and natural births at the hospital working alongside a Doula.

The issue I am pondering is the emergence of “humanized” obstetricians attending home and water births. In this situation, male (mostly) obstetricians work alongside female doulas to increase access to normal birth. Midwifery is declining across the country and many countries lack midwifery training systems and recognition, for example Mexico only has one officially recognized midwifery school. In the north of Mexico there are very few traditional or formally educated midwives. The positive aspect of this diad is obviously increased access to care. However as a midwife many questions emerge, such as where do midwifery skills go within this practice? What are the outcomes? How is fetal positioning addressed? Are natural remedies used? My sense, from conversation with “humanized” obstetricians and doulas is that practice, like with any midwife is particular to each obstetrician. Some are much more open to learning from midwives and others feel that as obstetricians they have the knowledge they need. The general sense (not confirmed by data) is that cesarean rates are much higher. Barbara Katz Rothman suggested to a Venzuelan obstetrician that he should leave the births to the midwives and focus on providing humanized obstetric services. However, how many practicing midwives are there in urban Venezuela? Not many.

Although on one had I do believe that this diad is necessary and I am strongly in favor of increased access to normal birth. However, this diad emerges in the absence of midwifery. Where are the midwives? Some of these doctors have explained to me that they attend over 15 births a month. Can this replace midwifery care? 15 births a month?? When are home visits done?! Again, this clearly demonstrates the need to have more midwives. My concern about this diad is that it may imply that midwives are not necessary, that its sufficient for an obstetrician to attend homebirth in order to protect the space of normal birth. As midwives we know that our skills extend further than protecting normal birth and our outcomes are so good because of our skills in counseling, nutrition, herbs and homeopathy, fetal positioning and many more.

From informal conversations with the obstetricians I often get the sense that they don't feel that midwifery has much to teach them. They sometimes (please do not get the sense that I am generalizing) give me the sense that they insist upon the hierarchy within which they were trained and that their skills are sufficient. They state proudly that one of the benefits of their care is that is they transport, care is continued. Where I can see the benefits of this, it also makes me wonder, well how often do you transport?

Another issue that I see in this diad is almost a mind/body split. Seeing it physically I imagine that midwives have clinical and decision making skills that work within our intuition, nurturing and continuity of care. Within the obstetrician/doula homebirth model, it seems as through the midwives right and left brains are split into two people: an obstetrician who can diagnose, run an IV and make a difficult decision and a Doula who provides continuity of loving care. I have observed my reaction to this and I'm not sure if my skills and intuition could be split. So many times in prenatal or postpartum care the attention given is based on a sage combination of these skills.

I am curious to have more conversations with women who are attended by the obstetrician/doula, curious to see their results and outcomes and curious to ask them many, many questions. I also curious about whether or not midwives see this as an opportunity to stand in our ground as the experts in normal birth, as that is what we are trained for, and to train more midwives.