Thursday, 20 September 2012

Who's your midwife?

So who is your midwife?

Normalizing natural birth...

We seem to have reached a place in obstetric care where interventions, even unnecessary interventions, are so normal that they aren't even noticed. Here in South Africa, most middle to upper-class women automatically hire a gynae (pronounced guy-knee aka OB-GYN) to deliver their babies. For me, that felt like calling a paramedic when I have a cough

In private hospitals here, the midwives employed by the hospitals actually get into trouble if they deliver the baby as then the gynae can't collect his full fee, but they also get into trouble if they call the gynae too early, because he (sometimes she) has a busy practice to run. And they need those busy practices because of the incredible insurance they have to pay.
I digress...

Within the last week I attended two screenings of the documentary Freedom for Birth (trailer above) which is about how women's rights are being violated in childbirth  - among a host of other issues related to birth. While I will be addressing this issue again, it really struck me how natural birth needs to be re-normalized.

I am always trying to encourage women to find a caregiver who trusts that a woman's body is designed to give birth, not someone who sees a pregnant women as a emergency waiting to happen. So I chose to have a private midwife in PMB, Arlen Ege, attend the birth of my second daughter at home. When I had my daughter, she was allowed to deliver babies at the local Mediclinic, but has since received notice that this would no longer be allowed. UPDATE: Sr Arlen Ege is once again able to do water births at Mediclinic in Pietermaritzburg as they have installed an outlet pipe for her birth pool! I was able to attend the birth at which this pipe was first used, also the first birth in a while in which a doula was allowed at Mediclinic - It was a beautiful VBAC in December 2013 - Birth Story to follow! 

Why I have to be a midwife...
But, how do we normalize natural birth? How do we help women to see that over 80% of them should be able to give birth naturally, when the current caesarean rate in our private hospitals is over 70%? Because when the number of caesarean births gets too high, they actually start causing more harm than they prevent...

Which brings me to my little revelation... In the city in which I live, Durban, with a population of 3.5 million, there are two practicing private midwives that I know of. If I am mistaken, please correct me, but even if there were 10, or even 50, that would still be too few.

How do we change the tide and restore midwifery care as the norm rather than the exception?

Well, what I've decided to do as my first step, is that whenever I get into a conversation with a pregnant lady, 'Who is your gynae?' will not be one of my opening questions as it usually is among my peers. My first question will be 'Who is your midwife?', and after that perhaps 'Have you found a doula yet?' You get the idea.

Language is such a powerful thing. Doctors use it all the time when they play the big baby card, or the 'but-your-vagina-will-never-be-the-same' card, or the 'If-you-were-my-wife-I'd-recommend-a-caesarean' card. What are you going to do to help normalize natural birth?

Tuesday, 18 September 2012

Redefining Identity at Age 30...

I thought this was what the early 20s were for...

Confession time: 
I've never seen myself as a particularly caring person. 
Passionate, yes; caring, not really.

Me in one of my Fiercest Mama moments!
I've always admired people who could care for others - especially the frail and infirm of all ages. As a young person I was a little shocked at how indifferent I felt. 

Even when I had my first daughter I wasn't overwhelmed with love as some moms describe - it took a couple of incidents that awakened my inner 'mama bear' for me to see that I loved my daughter with the fiercest love I've ever known. It got much easier with my second...

I am passionate about justice and fairness and sustainability and other such things. For example, I do my utmost to only buy clothes made locally as cheap imported clothing undermines local industries. I can't complain about unemployment and crime if my actions are contributing to the problem. The thing is, this passion arose more out of a sense of justice than out of love.

But, as I start to move into a more directly caring vocation - doula work specifically - and as I try to practise empathy in disciplining my daughters, in a sense as I start to do the work of caring, I find myself becoming a more genuinely caring person. 
I find myself overwhelmed with love and empathy for complete strangers.
I do think it has something to do with the fact that I feel like I'm coming out of a spiritual hibernation. A couple of months ago I had a picture of myself as a 'mama bear' (not that we even have bears here in South Africa!) climbing out of her den (do bears live in dens?) and stretching and blinking in the sunlight. She was on the thin side, and a little weak, but she was enjoying the warmth and the promise of newness and life.

So maybe it has something to do with this spiritual re-awakening - as I lean into this infinite love, strength and wisdom more and more, so I can give love, strength and wisdom into the lives of others. Perhaps I had practiced indifference because I just felt the weight of suffering too keenly. But as I start to understand this Saviour who carried all the suffering that ever was or ever could be, who could empathize to the utmost, so I start to see how I don't have to be paralysed by the suffering of others because he already carried their suffering in himself - and so I can truly be free - free to love with a fierce love, rather than a desperate love.

Tuesday, 11 September 2012

My first Caesarean Birth

My first Caesarean Birth...

Well, it wasn't my first Caesarean birth, but the first Caesarean birth I've had the privilege of witnessing 'in the flesh' so to speak. So during my first experience at an MOU I was asked to support a lady who needed an unplanned Caesarean birth. I'm not so keen on the term 'emergency' Caesarean because that gives the impression of something along the lines of an episode of ER where everything happens STAT! Sometimes it is like that, but it can take at least half an hour, sometimes a couple of hours to get into theatre if mom and baby are doing fine otherwise.

So I waited with her for one of the operating theatres to be ready, and when there was finally a spot I went off with the midwife to put on scrubs. I felt a bit spare taking a full on pic of myself with outstretched arm, so I managed to get a discreet shot of my feet to record the moment...

She was very tired and a little nervous about the operation, so I was glad I was able to go with her to theatre. It was quite cramped as the larger OT (operating theatre) was being used, so I couldn't sit next to her to be on the same level with her. I had to stand next to her and take up as little space as possible. 

From my vantage point I was able to see everything that was going on. I didn't watch how they got the baby out, but just spoke to the mom. It was difficult to communicate as English is not her mother tongue, and she couldn't see me talking because of the mask, so I just tried to make my eyes look as kind as possible and tried to sound as encouraging as possible!

She had a beautiful little boy who the nurse brought to say hello once he was wrapped up. The nurse let her rub noses with him which was very touching. She was exhausted and nauseous and she didn't really want to talk, so I held her hand and was able to watch while they stitched her up. I'm not easily grossed out - so I was quite fascinated to watch how they stitched up her uterus while it was perched on her belly, and massaged it to make it contract and stop bleeding, and then did the final stitching. It was a bit odd being in scrubs, and as my 'Childbirth Companion' apron had to be left in the change room, everyone wanted to know who I was and why I was there, so I got to explain what a childbirth companion / doula does.

So when I had to leave the mom still hadn't chosen a name, but asked what my name was and said that was what she wanted to name her son. It's a good thing Leigh is a unisex name! I'm not sure if she eventually did, but I was quite touched by the thought.

Another First: Doula Experience at an MOU

My first MOU doula experience...

For the uninitiated, an MOU is a Midwife Obstetric Unit - run by midwives, sometimes attached to a hospital and designed to serve low-risk women with little or no doctor intervention. It sounds like an ideal situation, and this specific institution is quite unique in South Africa, but does have it's own set of challenges...

Image from here.

As part of our training we need to observe some births and, fortunately one of the ladies doing our course, Hayley, conducts workshops for lay doulas and those who are contemplating professional training. These workshops include an opportunity to serve underprivileged women through labour and birth, so it made sense to join her to get a chance to observe and support some births. So, myself and my friend, who was still not sure as to whether this doula thing was right for her, again made sure the littlies were taken care off, donned our aprons to identify us as childbirth companions, and made our way to meet Hayley and another trainee doula at the MOU.

I had already been at one home birth and one labour (a home birth transfer) other than my own two births before I started the doula course, but I had no experience as a doula in a hospital environment. Eeek!

The women there very seldom have partners with them, so we were welcome to help whoever needed us. One lady had already been booked for a caesarean so I was able to sit with her while we waited for the OT (operating theatre) to become available and was able to go with her into theatre. You can read more about that here.

When I got back to the ward, there was a lady who was quite close to giving birth who my other two trainee doula friends had been supporting, so I was able to join them. It seems that it is standard practise for the women to have catheters, and she also had a drip so she was on the bed for the birth. She kept wanting to reach up and grab a rail above her to pull on it. I have read that pulling on something does help to push, and lifting her weight off the bed would have helped her have more of a squat position, which would have been great, so I thought it was incredible that she knew just what her body needed, but unfortunately the rail was not designed to hold a labouring woman's weight so we let her pull on us instead...
I realized why we were advised to take rings off. The vice-like grip of a woman in the throes of transition is not to be underestimated!
She also gave birth to a boy, and you could just see how happy she was that her little one was finally in her arms! I did take a photograph but wasn't sure if I was keen to post it without asking her permission, so I will make sure I do that for future births!

After this, my friend who hadn't been sure was convinced that this was definitely something she wanted to do - and I thought she was doing a great job! It has been really lovely to have a friend to walk this journey with, I am so grateful!

The other trainee who was with us was so hyped up by the birth! I completely understood where she was coming from, and I expected to feel the same, but I felt more sobered than anything else. I think the fact that my hubby forgot to fetch my daughter from school had something to do with it, as I was awakened to the realities of dashing off to support women at unknown hours for undetermined lengths of time. Don't get me wrong, he is VERY supportive; it was an honest mistake, and my mom was nearby to help out, but mom is moving 3 hours away in the very near future to start a bed and breakfast in Hluhluwe, so it looks like childcare is a one of the bigger challenges to be overcome in this Durban Doula's journey...

Friday, 7 September 2012

My first important lesson about being a doula.

Our First Workshop...

With deposits paid, kids taken care of, and much anticipation, myself and and a friend made our way to Hillcrest Private Hospital for the first workshop of our doula course. There were only 6 places on the course, so we were really able to get to know each other, which I appreciate because it is encouraging to be around like-minded people!

To start with we all shared a bit about ourselves. Actually, I lie, we all shared a lot about ourselves. Ask a woman to tell you about her self, her child, her births and her passions and you'll get the idea. It was lovely to listen to all the stories and through the sharing someone remarked that most of us had pretty strong personalities.

So I had my first little revelation. It seems that doula needs to have a sense of strength and independence about her to want to be a doula in the first place. The important thing is that it should not be a strength that dominates, but rather a strength that empowers. A doula is not there to rescue the mom and be the star of the show, but to reveal to the mother, and her partner, the strength they already have. So I realized I really need to work on my watching and listening skills, but to do that I just need to learn to keep my mouth shut sometimes. So just as all the facts and figures are an important part of our training, I think these little self-revelations are pretty important too...

Welcome to this Durban Doula's Diary!

First things first, if you don't know what a doula is, she is a lady who supports women and their partners before, during and after childbirth. You can check my website here for more info. (Will open a new window.)

Secondly, if you're wondering where Durban is, it's on the eastern coast of South Africa. That's the country on the southern tip of Africa, in case you missed it.

To clarify from the start, I was never a 'baby person'. At one stage I didn't even want children, ever. If you had told me 5 years ago I wanted to spend my time and energy helping moms and babies, I would have thought you were smoking your socks.

The births of my two daughters, one natural drug-free birth in a hospital and one water birth at home, were the best experiences of my life. I have become passionate about helping other families have positive and affirming birth experiences. For more info on that, check my page on Why I want to be a midwife. (Will open a new window.)

So yeah, I will be studying to be a doula through WOMBS (Women Offering Mothers Birth Support), an organization based in Cape Town (bottomest, leftest tip of Africa). It is a six month course, running until December 2012. I am so excited about the possibilities this opens up to me! To be honest, I was thinking of only starting my studies when my kids were a little older (they are now 13m & 43m) but my hubby could see how crazy I am about all this stuff, and he encouraged me to just go for it. He knows this is what makes me come alive! 

So my intention is that this diary will show you a little of what it takes to be / become a doula, including the lessons learned and wisdom gained, and possibly inspire you in your journey towards what makes you come alive!