July 23, 2007 § Leave a comment
stuff that i have learned from the last few births:
people get really excited during the pushing time. the voices get louder and more insistent and urgent. and it is all about pushing three times during each contraction. but i saw a baby come out with a broken collarbone, the shoulder was stuck during the pushing. and so rather than focusing on pushing we can focus on opening. creating conditions that make opening ripe.
and we can create the conditions around the birthing space and within the space that allow women to have the courage to step toward the pain. for a long time i have disavowed the word courageous. i remember being at a small press fair fundraising to go to palestine and one young man said i had courage. but i didnt feel like a superhero. actually in preparing to go to palestine i felt quite the opposite. but now i see that we all have courage and it is not about being a superhero (or supervillain) rather it is an intimate knowledge with our own strengths and vulnerabilities. and it is this quality of knowledge that we must hold the space for women to discover themselves. the space and the time.
and some people are going to resent the very presence of the doula. feel as if her presence is testimony to their own weakness and inability to handle the birth. and we can guide witnesses toward labor support. it is the simple small gestures that matter in labor support.
July 13, 2007 § Leave a comment
right now i have a mama at home laboring until she goes to the hospital. i wish that more of my clients would labor at home as much as possible. often being at home is more relaxing and comforting than being at the hospital. as well they can move as they like and sound as they like in relative privacy. psychologically and emotionally they can work out whatever hanging issues in their life, rather than having the fears and doubts about things outside and inside of the birth popping up when they are in the hospital and so removed from their everyday lives. and birth can become a part of the everyday life, more fully integrated practically and emotionally, so that when the women return home the break between the before birth and after birth, the change in identity and responsibility transition smoother. also they can establish their own rituals and rhythms of managing the pain and feel more capable to do so when they enter the hospital.
July 12, 2007 § Leave a comment
last night i was at a birth in one of the hospitals downtown. she was 20. her boyfriend the baby’s dady was in jail on a federal charge. at any one time there were 5-10 of her closest friends and family and me, the doula, and her, the woman in labor.
she never really cried out in pain. instead she held it all in. tears in her eyes but no sound. she arrived at the hospital at 1 cm dilation. and i new it was going to be a long day. she went to 3 cm before asking for the epidural. maybe she wouldnt have needed the epidural if she had not felt the need to hide all her pain, not express it. it was hard for me to know that she was having a contraction. she would get quiet, tense her lips, make her body rigid. but there was her younger sister there and her younger sister’s best friend and her best friend/baby godmother and another friend who was determined to see a birth after her csection. there even more cell phones and ringtones and difficult birth stories and jokes and text messages. and then the grandmother and the grandmother in law and some other friends dropped by. it was so loud and exhausting and i found it difficult to connect with her because of the noise and 3 or four conversations and the television. the epidural stopped working on one side and i massaged her hips and obliques until the doctor finally came to readjust the epidural. she hates needles.
she was amazingly strong and stoic. but when it came for her to push the nurses came in to the party looked at the little boy on the floor sleeping and said that some people would need to leave there were just too many. so the grandmothers decided to leave. and i stepped out. and the nurses looked at us like we were crazy. how could we leave her with three 17yearolds? three very insecure 17 year olds.
a couple of hours before the doctor had told her that she had not dilated past 6 cm for the past 3-4 hours and so they wanted to break her water and give her pitocin. she asked for the doctors to leave and then the whole room the whole crowded room gave their opinion. i asked her what were the benefits, the harms, the alternatives of the inductions. artificial oxytocin aint like the real thang. and that bag of water is there fro a reason. it provides cushioning during the labor. is a shock absorber for babys head against the cervix. the younger sister accused me of wanting her ‘to do it natural’. i had an epidural, pitocin, my water broken, and csection in my birth so i am obviously not completely against inductions. i also planned for a home birth so i am not against the ‘natural’ approach either. i just want to give her the information so that she can make an informed decision. everyone was tired. wanted the birth to over. wanted to go home get some sleep go to work in the morning. this is not my birth it is her birth. she decides to get pitocin but no water broken. the earlier doctor had said that there was no medical reason to break the water studies show. the earlier doctor was a woman and respectful with a little nose ring. more noninterventionist than some midwives i know. and calmer.
i decided to go home and went to gather my stuff from the family lounge that the two grandmothers and i were inhabiting waiting for the birth. oprah was on the tv. her show was about siblings. the first successful african american sextuplet birth. i had taken a walk. the mother had gone to check on the birth and it turned out that ‘nothing was happening’. she wasnt pushing. there was a little lip of cervix still hanging out. i told the grandmothers that the soon to be mother needed to relax her mouth. she needed to scream. she has been holding it all in and now she needs to let it out. it is the sphincter law of ina may gaskin. it is the reason we have to make noise when we take a shit.
as i was in the car with the maternal grandmother in the parking lot about to go home, she gets a call that the baby is born. we go back to the hospital. i see the baby boy. and the paternal grandmother takes me aside and says that she told the mother what i had said and it worked. she didnt have to push the baby just slid out after she finally opened her mouth. i smiled. and slipped out the door blowing a kiss a blessing to the crowd. on the bed, the mother was pushing out the afterbirth. bloody umbilical cord between her legs.
‘A 1993 study by Kennell, Klaus and Kennell showed that women who have doulas during their labors experience:
50% reduction in cesarean rates.
25% shorter labors.
60% reduction in epidural requests.
40% reduction in the use of pitocin.
30% reduction in requests for pain relief.
40% reduction in forceps deliveries.’
July 9, 2007 § 4 Comments
so this little article comes from the site of international center for the tradition of childbirththe black midwives site. i wish that there was an unbroken tradition of rituals as is described in the first paragraph, but our traditions our history are broken. i see the acts of colonization genocide enslavement as the breaking of our history of our tradition, the maafa–the middle passage, as the break between the past and the future and we have to find a way to heal this break. part of that healing is to find powerful rituals today that can create community. and by creating community sustaining community, a community of equals a community that engenders mutual liberation of its members, we heal from the break. because traumas personal cultural social historical traumas move into a healing place when we feel and believe and act as if we are powerful and relevant to others. when we can live our own worth. when the new selves that we created in the traumas have a home. when they have created that home of love for themselves.
what was the name of that first black midwife? what did she learn about birth and death in the middle passage? what did she learn about the power of the female body? all i can imagine around her on that boat is blood and shit and her having to midwife women with her and her in chains. and her teaching women how to kill their children with prayer and calls to the ancestors.
and what was her name?
History of Black Midwives
Long ago, and in many parts of Africa today, midwives were revered, loved and depended on by the entire village. The Grand-midwives taught the apprentice midwife the traditional rituals of womanhood, childbearing and family care. These sacred rituals included prayer, homage and respect for the ancestors, massage, and preparation of food, breastfeeding, postpartum care and much more.
Sharon Robinson, critic and professor of midwifery and black health care systems, states in her 1984 study for the Journal of Nurse-Midwifery that the first Black lay midwife came to America in 1619, bringing with her a knowledge of health and healing based on her African background.
The most popular story about the good work of midwives comes from the Bible (Exodus 1:14 through Exodus 1:22). It tells of the Egyptian midwives Shiphrah and Puah, listening to the voice of God and refusing to kill the first-born sons of the Hebrews as Pharaoh had ordered.
Midwifery has always been an honored and spiritual profession among Africans who continued their rich traditions, even while enslaved. Historically Black midwives have saved the lives of countless mothers and babies throughout the United States. Both free and enslaved Black midwives provided midwifery care not only to their communities but also to families outside of the Black community.
The word “midwife” in many African languages is synonymous with spiritual healer. The Traditional Midwife’s calling expanded beyond catching babies; she was a healer, a spiritualist, a Public health activist and a community organizer. A woman entered into midwifery through several doors, a calling from God, appointed by the elders, chosen by an older midwife or moved by community need.
July 9, 2007 § 1 Comment
and this is miriam perez whom i just discovered a couple of days ago. (heard a great joke on the simpsons: i discovered it just like christopher colombus, i discovered something millions of people already knew about) she has a blog called: radical doula
i think that there are alot of similarities between being a doula and doing accompaniment work. when i do accompaniment work of people and communities under the threat of violence i am having to communicate with these authorities in their official uniforms and their protocal and their just following orders. many of whom really do think that they are doing something good for the world by dehumanizing people who are weaker than they are. they are doing it for her own good. obsessed with creating security– doing everything that is possible to do that empowers the authority and makes life safe– sanitized extra precautions worried and the medical model of pre-emptive active management birth. and this pre-emptive strike medical policy works as well with a birthing woman as it did in iraq. trying to control every possible minute chance of chaos. but life is self organizing chaos and so is birth. and so we have to co create a space that empowers the woman and community that nurtures them having the time and space and energy to choose what they need and how they are going to achieve it and supports them in life affirming acts.
and i have thought about being a doula an accompanier a companion at clinic abortions and home abortions. i have known women to cause spontaneous miscarriage/abortions with visualization and prayer. how do you make that illegal? why cant we as a culture accept the fact that there are some women who have an intimate relationship with life and death. that life is a multifaceted concept that some women have to struggle with inside themselves in the end and as for the ridiculous question of when does life start: i think that for each of these women the answer is different. life is not absolute but it is contextual. situational. fluid. like a river. or a thought. or a slow dance.
the best accompaniment work i saw were blacks accompanying blacks who were detained by the police. i loved copwatch. replacing the gun with the video camera and the replacing the video camera with our bodies and the intimate empowering trust we develop with our bodies.
Being a Radical Doula
How pro-choice advocacy and birth activism go hand in hand.
By Miriam Pérez, Swarthmore College
Monday April 16, 2007
How can the same person be a pro-choice activist and a birthing-rights advocate devoted to supporting women through childbirth? When I became interested in the rights of pregnant and birthing women in college, I never imagined there was a contradiction between my pro-choice politics and my newfound passion for midwifery. But a few months ago, Lynn Paltrow, executive director of the National Advocates for Pregnant Women, clued me into a longstanding divide between the pro-choice and birthing communities. She and her organization put together a groundbreaking conference that attempted to bridge the gap between these two groups, who rarely talk about each other’s issues.
Abortion had never been addressed at the midwifery conferences I had attended, and the issue gets little mention on the websites of the most prominent midwifery and doula organizations. (A doula is a person trained to provide support to women in labor.) Initially these silences led me to believe that birth activists held my pro-choice beliefs, but I recognize now that they are actually a sign of discord. Rather than address what can be a controversial topic (particularly for a movement that includes religious midwives and doulas), most birthing rights advocates choose to avoid the topic of abortion entirely. With a confirmed focus on the pregnant woman and her journey toward birth, such a high value can be placed on motherhood that it becomes difficult to condone practices like abortion. Similarly, within the pro-choice movement, such a large emphasis is placed on the rights of women not to parent that one can forget about the rights of women who choose to parent.
When I was thrust into the world of what I call “birth activism,” I approached the issues with my usual attitude: People who didn’t get it just didn’t have the facts yet. They hadn’t seen what I’d seen or read what I had read about how terrible the current state of childbirth is in the United States, particularly in the hospital setting. The documentary “Born in the USA” plainly demonstrates how much better midwives and out-of-hospital settings are for low-risk births, and how the bureaucratic obstetrics ward contributes to a landslide of unnecessary medical interventions that aren’t good for mothers or children. Childbirth in its current form—attended by an obstetrician in the hospital—has only existed since the 1920s. Before that time, midwifery care in the home was the standard practice. According to author Karla Hay, before 1900 only 5 percent of American births occurred in hospitals. By 2000, the Centers for Disease Control reported that 99 percent of births did.
What’s wrong with all this? There are many negative effects of the medicalization of birth, but let’s keep it simple. Childbirth is more medicalized now than ever, with more interventions, more drugs, and more surgeries. Our Caesarean section rate is up to around 30 percent, despite World Health Organization recommendations of 15 percent. Are women and babies healthier? Safer? Happier? The answer is no. The United States continues to rank near the bottom of developed countries in relation to infant mortality, coming in second to last in 2006. Experts disagree on why. Some cite sub par health care for low-income pregnant women, while others point to increasingly complicated neonatal surgical interventions for otherwise unviable pregnancies. The simple fact is that Americans have one of the most costly health care systems in the world, but in many respects our health outcomes are nothing to brag about among our developed-world peers.
Beyond all of this, what the birthing rights movement addresses is the narrowing scope of women’s choices about how they give birth. Hospitals and doctors have increasingly specific requirements and regulations about childbirth, many times based on standardized ideas of how a “normal” birth progresses. When women fail to meet these standards, interventions are employed, many of which are costly and cause a landslide of further intervention. Let’s not forget the emotional and psychological component. Many women give birth in environments where they feel unsupported, a fact exacerbated by hospital staffers who are overworked and face increasing productivity demands. They instead rely on family to give emotional support, but not all women have the familial support they need or want.
Birth activism provided me with a new outlet for my feminist politics and a way to support women during an important time in their lives. After a harrowing experience in a public maternity ward in Ecuador, where I briefly lived, I became a doula, accompanying women during labor. Unfortunately, working as a doula—while an incredible opportunity—was not the empowering experience that I had hoped it would be. I found that I had little ability to influence births and I could be in the birthing room only as long as I kept my mouth shut and stayed out of the way. I accompanied four women during their labors and deliveries in this hospital, but by then I was at my breaking point.
Activists working in the abortion-rights field have similar experiences. It is almost impossible for a woman to have an abortion in a totally safe and supportive environment, free from social and familial stigma. No matter how much we pro-choice advocates fight, there will always be a loud and ever-present group on the other side (often just outside the clinic doors) telling women they should feel guilty about their choices and that they are based on selfishness and sin. Women are rarely allowed the freedom to make these choices in the idealistic environment that we abortion-rights advocates dream about, free from the influence of divisive politics. This is where the connection between abortion-rights advocates and birth activists seems exceedingly clear to me: Both are attempts to fight back against rhetoric that prioritizes the unborn fetus instead of the adult woman.
When a woman is giving birth in an American hospital, the doctors, nurses, and extended medical team are almost wholly focused on the status of the fetus inside of her—constantly employing technologies to monitor it and drugs to regulate it, allowing fetal well-being to be their dominant concern. When we think of a woman with an unintended pregnancy (and this could be the same woman, in a different phase of her life), a similar logic applies. Anti-choice activists don’t trust women to make responsible decisions about their lives and ability to parent; they instead focus on the potential life inside a woman, and place all emphasis on the future of the fetus rather than on the future of the woman. Anti-choice activism and overly-medicalized birthing practices are both based on a lack of trust in women. Consider the many restrictions imposed on birthing women: rules regulating out-of-hospital midwives, mandatory waiting periods for abortions, forced C-sections, and biased pre-abortion counseling are all examples of how people do not trust women (or their support networks) to make responsible decisions about family well-being.
What is unique about the role of the doula is that she gets to be one of the only people in the birthing process exclusively focused on the woman. She focuses entirely on how the woman is feeling, providing accompaniment and support through a process that can be scary and lonely, particularly in a hospital. Studies show the positive effect that this kind of unconditional support and attention can have on both the mother and her child. That’s the logic that really connects the birthing and the pro-choice movements—if we support women and their decisions, everyone will fare better, including children.