A Chanukah Blessing for Raquel & Jacob

Raquel Lazar Paley and I have worked together for the past two years.  After I spoke at the ICAN Conference in San Diego, CA, she invited me to put together a program to teach online at ConsciousWoman.  She has just had her first homebirth and she sent out this announcement and photos today.  I’m so proud of Raquel and Jacob and so glad that we met.  .  .  as our mutual friend, Nancy Wainer Cohen, said it was nice that Raquel had a birth with “no shenanigans”. 

_____________________________________________________________________

 

We are pleased to announce the newest addition to our family,

GABRIEL ASHER
“strength” “happiness”

Born into his father’s loving hands on December 22, 2008 at 10:17 p.m.

Weight: 7 pounds
Length: 19 inches
Head Circ: 14 inches
Most Importantly: nursing like a champ

* Raquel’s second VBAC and first homebirth *

Big sisters Amelia and Sofie are thrilled with their little brother, and mom is thriving as all (new) mothers should.

Gabriel Asher will be the first male child in our longstanding Jewish family tradition to remain intact.

 

A special thanks to Gloria Lemay for her phenomenal care during the labor, delivery and postpartum, and to our local backup midwife Kristine Lauria for her support and encouragement while Gloria was on her way to Colorado.

Happy (Belated) Holidays
and
Happy New Year!

Pushing for Primips

This article originally appeared in Midwifery Today Magazine, Issue 55 (Winter, 2000). “Primips”-women having their first babies.

by Gloria Lemay
The expulsion of a first baby from a woman’s body is a space in time for much mischief and mishap to occur. It is also a space in time where her obstetrical future often gets decided and where she can be well served by a patient, rested midwife. Why do I make the distinction between primip pushing and multip pushing? The multiparous uterus is faster and more efficient at pushing babies out and the multiparous woman can often bypass obstetrical mismanagement simply because she is too quick to get any.

It actually amazes me to see multips [women having second or more babies] being shouted at to “push, push, push” on the televised births on “A Baby Story”. My experience is that midwives must do everything they can to slow down the pushing in multips because the body is so good at expelling those second, third and fourth babies. In most cases with multips, having the mother do the minimum pushing possible will result in a nice intact perineum. As far as direction from the midwife goes, first babies are a different matter. I am not saying they need to be pushed out forcefully or worked hard on. Rather, I say they require more time and patience on the part of the midwife, and a smooth birth requires a dance to a different tune.

Let’s take a typical scenario with an unmedicated first birth at home. The mother has been in the birth process for about twelve hours. The attendants have spelled each other off through the night. Membranes ruptured spontaneously with clear fluid after eight hours in active phase and mother and baby have normal vitals. There is dark red show (about two tablespoons per sensation) and mother says, “I have to push!” This declaration on the part of the mother brings renewed life to the room. The attendants rally and think,

Finally, we’re going to see the baby. The long wait will be done. We’ll be relieved to see baby breathe spontaneously. We can start the clean up and be home to our families.

Typically, the midwife does a pelvic exam at this point to see if the woman is fully dilated and can get on with the pushing now. It is common to find the woman eight centimeters with this scenario. The mood of the room then turns to disappointment.

My recommendation with this scenario: Don’t do that pelvic exam. A European-trained midwife that I know told me she was trained to manage birth without doing pelvic exams. For her first two years of clinic, she had to do everything by external observation of “signs.” When a first-time mother says, “I have to push!” begin to observe her for external signs rather than do an internal exam. Reassure her that gentle, easy pushing is fine and she can “Listen to her body.” No one ever swelled her own cervix by gently pushing as directed by her own body messages. The way swollen cervices happen is with directed pushing (that is, being instructed by a midwife or physician) that goes beyond the mother’s own cues. It has become the paranoia of North American midwifery that someone will push on an undilated cervix. Relax, this is not a big deal, and an uncomfortable pelvic exam at this point can set the birth back several hours. The external signs you will be looking for are as follows:

1. When she “pushes” spontaneously, does it begin at the very beginning of the sensation or is it just at the peak? If it is just at the peak, it is an indication that there is still some dilating to do. The woman will usually enter a deep trance state at this time (we call this “going to Mars”). She is accessing her most rudimentary brain stem where the ancient knowledge of giving birth is stored. She must have quiet and dark to get to this essential place in the brain. She usually will close her eyes and should not be told to open them.

2. Does she “push” (that is, grunt and bear down) with each sensation or with every other one? If some sensations don’t have a pushing urge, there is still some dilating to do. Keep the room dark and quiet as above.

3. Are you continuing to see “show”? Red show is a sign that the cervix is still dilating. Once dilation is complete the “show of blood” usually ceases while the head molding takes place. Then you can get another gush of blood from vaginal wall tears at the point that the head distends the perineum.

4. Watch her rectum. The rectum will tell you a good deal about where the baby’s forehead is located and how the dilation is going. If there is no rectal flaring or distention with the grunting, there is still more dilating to do. A dark red line extends straight up from the rectum between the bum cheeks when full dilation happens. To observe all this, of course, the birthing woman must be in hands and knees or side-lying position.

I use a plastic mirror and flashlight to make these observations. The woman should be touched or spoken to only if it is very helpful and she requests it. Involuntarily passing stool is another sign of descent and full dilation. Simply put, where there is maternal poop there is usually a little head not far behind.

Added to original post on March 25, 2015: A good question to ask the birthing woman when she says ‘I HAVE TO PUSH” is: ” Where exactly do you feel it, when you say you have to push?” wait for the answer, don’t give any hints. If the woman points to her low belly, it simply means that the baby is surging down in the pelvis but there is still dilation to do. The baby pushing down is not second stage. Second stage is felt all in the bum. . . very different thing. When the baby is surging down and pushing in the front, that all right but it’s not what hospital personnel mean by “pushing”. As a doula, you can prevent them from getting excited to do a pelvic exam by saying “My client is feeling downward surges of the baby in the front, she has no rectal pressure, yet.”

Why avoid that eight-centimeter dilation check? First, because it is excruciating for the mother. Second, because it disturbs a delicate point in the birth where the body is doing many fine adjustments to prepare to expel the baby and the woman is accessing the very primitive part of her ancient brain. Third, because it eliminates the performance anxiety/disappointment atmosphere that can muddy the primip birth waters. Birth attendants must extend their patience beyond their known limits in order to be with this delicate time between dilating and pushing.

Often when the primiparous woman says, “I have to push,” she is feeling a downward surge in her belly but no rectal pressure at all. The rectal pressure comes much later when she is fully dilated, but in some women there is a downward, pushy, abdominal feeling. I have seen so many hospital scenarios where this abdominal feeling has been treated like a premature pushing urge and the woman instructed to blow, puff, inhale gas and so forth to resist the abdominal pushing. Such instruction is not only ridiculous but also harmful. A feeling of the baby moving down in the abdomen should be encouraged and the woman gently directed to “go with your body.”

When I first started coaching births in the hospital I would run and get the nurse when the mother said, “I have to push.” I soon learned not to do this because of the exams, the frustration and the eventual scenario of having to witness a perfectly healthy mother and baby operated on to get the baby out with forceps, vacuum or c-section. I have learned to downplay this declaration from first-time birthers as much as possible, both at home and in the hospital. Especially if you have had a long first stage, you will have plenty of time in second stage to get people into the room when the scalp is showing at the perineum.

Feeling stuck
I recommend that midwives change their notion of what is happening in the pushing phase with a primip from “descent of the head” to “shaping of the head.” Each expulsive sensation shapes the head of the baby to conform to the contours of the mother’s pelvis. This can take time and lots of patience especially if the baby is large. This shaping of the baby’s skull must be done with the same gentleness and care as that taken by Michelangelo applying plaster and shaping a statue. This shaping work often takes place over time in the midpelvis and is erroneously interpreted as “lack of descent,” “arrest” or “failure to progress” by those who do not appreciate art. I tell women at this time, “It’s normal to feel like the baby is stuck. The baby’s head is elongating and getting shaped a little more with each sensation. It will suddenly feel like it has come down.” This is exactly what happens.

Given time to mold, the head of the baby suddenly appears. This progression is not linear and does not happen in stations of descent. All those textbook diagrams of a pelvis with little one-centimeter gradations up and down from the ischial spines could only have been put forth by someone who has never felt a baby’s forehead passing over his/her rectum!

Often the woman can sleep deeply between sensations and this is most helpful to recharge her batteries and allow gentle shaping of the babe’s head. Plain water with a bendable straw on the bedside table helps keep hydration up. The baby is an active participant and must not be pushed and forced out of the mother’s body until he/she is prepared to make the exit. In her book “Ocean Born” (l989) midwife Chris Griscom describes her experience of allowing her son to push his own way out of her womb:

[I ask] . . . the cervix what color it needs to open easily, the color flashes before my eyes and I begin to visualize myself drinking that color directly into the cervix. I sense a subtle but immediate response. There is a quickening now. The baby is moving down, as I’ve begun the dreaming. Spun off time’s orbit, I sleep in the sea, until I feel it rise with the contraction. I surface like the dolphin, then dive again. Birth is coming. Gratitude for the ease of this passage floods me, and I feel salty, slow motion tears trace the outline of my face. Like a gigantic stone, the pressure of his head weighs down through my pelvic floor. With all my power I am pushing the stone . . . yes, I am also that stone myself. The motion catches me and I feel myself impelled faster and faster . . .
An explosion of light
I see the belly of a huge Buddha,
I am propelled into it
Rapture
Bliss
Ecstasy.

Do not disturb
For anyone who has taken workshops with Dr. Michel Odent, you will have heard him repeat over and over, “Zee most important thing is do not disturb zee birthing woman.” We think we know what this means. The more births I attend, the more I realize how much I disturb the birthing woman. Disturbing often comes disguised in the form of “helping.” Asking the mother questions, constant verbal coaching, side conversations in the room, clicking cameras—there are so many ways to draw the mother from her ancient brain trance (necessary for a smooth expulsion of the baby) into the present-time world (using the neocortex which interferes with smooth birth). This must be avoided.

A recent article on the homebirth of model Cindy Crawford describes how the three birth attendants and Cindy’s husband had a discussion about chewing gum while she was giving birth. Cindy describes her experience: “It was absolutely surreal. There I was, in active labor, and they’re debating about gum! I wanted to tell them to shut up, but at that point, I couldn’t even talk.” (Redbook, March 2000). This was in her own home, and she couldn’t control the disturbance that was happening in her first birth. Needless to say, she had a long, painful, exhausting second stage.

Model Cindy Crawford and her family

Model Cindy Crawford and her family


Human birth is mammal birth. A cat giving birth to her kittens is a good model to look to for what is the optimal human birth environment: a bowl of water, darkness, a pile of old sweaters, quiet, solitude, privacy and protection from predators. When given this environment, 99.7 percent of cats will give birth to kittens just fine. We spend so much money in North America on labor, delivery and recovery (LDR) rooms and now, adding postpartum, LDRP rooms. Yes, it is an advancement that women are not moved from room to room in the birth process, but there is so much more that can disturb the process: lighting, changing staff, monitoring, beeping alarms, exams, questions, bracelets, tidying, assessing, chattering, touching, checking, charting, changing positions and so on.
When midwives come back from the big maternity hospital in Jamaica, they bring an interesting observation about birth. The birthing women are ignored until they come to the door of the unit and say, “Nurse, I have to go poopy.” They are then brought into the unit and within twenty-five minutes give birth to the baby. Cervical lips are unheard of. Most times, the head is visible when the woman gets onto the birth table. Her entire eight-centimeter-to-head-visible time is done in the company of the other birthing mothers, and she is cautioned not to go near the midwives until the expulsive feeling in her bum is overwhelming. Cesarean section and instrument delivery rates are very low.

Reversing the energy

Birth is better left alone and pushing should be at the mother’s cues. Having said that, I want to address the exceptions to the rule. After hours of full dilation with dwindling sensations, what if the mother is languishing? The sense of anxiety and fatigue in the room builds, and nothing is served by allowing this to go on too long. Such situations often occur at first births, where the birthing woman insists on having her whole family present. This dynamic is one reason why vaginal birth after cesarean (VBAC) women are well-advised not to have spectators at their births. Birth is best done in privacy even if the woman desires on a conscious level to have visitors. In this type of situation the midwife can help by changing the direction of the flow. Normally we think of the baby coming “down and out.” In this scenario, nothing is moving. It’s a bit like having your finger stuck in one of those woven finger traps. The more the mother attempts to bring the baby down the more tired and tight the process becomes. At this point, it can be helpful to get the mother into knee/chest position and tell her to try to take the baby’s bum up to her neck for a few pushes. This will sound like strange instruction but, if she has learned to trust you, she will give it a whirl. Reversing the energy and moving it the opposite direction can perform miracles. After five or six sensations in this position with minimal exertion of the mother, the fetal head often appears suddenly at the perineum. For those of you who know Eastern martial arts, you will understand this concept of reversing directions in order to gain momentum. This is midwife Tai Chi!

Facing Fear

Psychological factors in birth are a never-ending source of fascination to some birth attendants. I try to keep it simple. My job is to facilitate birth not practice psychology. When I start to be afraid at births, the last thing I want to hear is someone else’s fears in addition to mine. This is a natural inclination but not helpful for moving energy and getting babies into the world. I have learned to notice when I’m fearful and respond to my fears by saying out loud to the mother, “Linda, what’s your biggest fear right now?”
Linda may take some time but eventually she’ll say something that I never imagined she’s holding as a fear. Usually it is enough for her to simply express it. Sometimes she needs some reassuring input. I find always that when fear is expressed it begins to disappear or at least lose its grip on the birth. Be bold about addressing fear and uncommunicated worry. One first-time birther responded to my question “What’s your biggest fear right now?” with “I’m afraid I won’t be able to open up and let my baby out.” As soon as the words were out, her baby gave a big push and the head was visible at the introitus.

Linguistics and concepts

Midwives have lots of research support encouraging them to be patient with the second stage and wait for physiological expulsion of the baby. Recognizing ways in which we can support the woman to enter that deep trance brain wave state that leads to smooth birth is imperative. I find it very helpful to have new language and concepts for explaining the process to practitioners. Dr. Odent has taught me to wait for the “fetus ejection reflex.” This is a reflex like a sneeze. Once it is there you can’t stop it, but if you don’t have it, you can’t force it. While waiting for the “fetus ejection reflex,” I imagine the mother dilating to “eleven centimeters.” This concept reminds me there may be dilation out of the reach of gloved fingers that we don’t know about, but that some women have to do in order to begin the ejection of the baby. I also find it valuable to view birth as an “elimination process” like other elimination processes—coughing, pooping, peeing, crying and sweating. All are valuable (like giving birth is) for maintaining the health of the body. They all require removing the thinking mind and changing one’s “state.” My friend Leilah is fond of saying, “Birth is a no brainer.” After all “elimination processes” are finished, we feel a lot better until the next time. Each individual is competent to handle their bodily elimination functions without a lot of input from others. Birth complications, especially in the first-time mother, are often the result of helpful tampering with something that simply needs time and privacy to unfold as intended.

The following appeared with the above article in Midwifery Today.

Pushing Situations: Hospital vs. Home

A hospital CNM wrote:

My physician colleague called me in as a consultant for one of his ladies last week. Primip at forty weeks plus three days, spontaneous labor, admitted at five centimeters and spontaneous rupture of membranes (SROM) around 8 p.m., with pretty bad back pain, resolved after injection of sterile water papules. Around 11 p.m. she was complete and wanting to push. When he called me it was 2:30 a.m., she had been pushing for most of that time and occasionally it seemed like the baby would move down, and then nothing. He had her pushing in all kinds of positions. I came in and worked with her for a long time. The baby was doing fine throughout and mom wanted to keep on trying. Around 4 a.m. we started seeing signs of fetal stress (tachycardic to the 170s), and mom was also getting more and more exhausted. Baby didn’t seem all that big, but was occipitoposterior (OP) and asynclitic. Went to OR, baby born around 5 a.m. with major molding of caput, delivered OP asynclitic and I heard the surgeon grunt as she and the family practitioner doc were pulling out the shoulders—a 4,110 gram (nine pounds, six ounces) baby boy. We tried every trick we knew to get that baby turned and out, it just didn’t work.
Caroline, CNM

Gloria’s reply:
We had a homebirth of a primip 4,876 gram (ten pounds, seven ounces) boy the other morning which sounds a lot like your situation. Gestation was forty-two weeks plus four days. Tall and big boned woman. She had four days of SROM prior to starting up. Good temperatures and fetal heart tones in that time. No exams. Complained about her back all through. Her babe’s head was plus one and she was fully dilated at 8 a.m. after a twelve-hour first stage. Then she slept and the sensations spaced right out. She got up to the toilet for a while, she went into the pool for a while, and then would start the whole cycle again—sleep, toilet, pool and sidelying on the bed. Mickey Mouse pushing that produced no advancement, but we didn’t disturb her or encourage anything strong. At 2 p.m. we got her up and had her squat and bear down with some ooomph. She pushed out a big boy on all fours into her husband’s hands with just a first-degree tear. Shoulders were a breeze. The birth attendant, who used me for a consultant in this case, called me in early and we both took turns to work with the birthing woman through the night so everyone was rested and there was continuity in the coaching. The other big advantage we had was being out of hospital, which gave us a lot more room to be “creative” and wait without the pressure of “science” and protocols looming in everyone’s mind. The toilet in one’s own home is a good place to let go, and we were able to “feed” her things from her own fridge that kept her strength up.

In our province the governing board wants midwives to do a certain number of hospital births a year in order to be licensed. I would have such a hard time working in that environment, especially with first-timers. When I think back on the years I did labour coaching in the hospital, I recall having a horrible time with primips. They almost always stalled out. We asked Dr. Michel Odent one time if it was OK to have the first baby at home. He replied, “Zis is zee most important birth to have at home because if a woman has a beautiful, sexual experience with her first birth then perhaps she can go to the hospital with her second or third. She will never let them do anything to her because she knows her body works from that first birth.” And then, we have Dr. Michael Rosenthal who says, “The first intervention in natural childbirth is the one the woman does herself when she walks out the front door of her house. It is from that first intervention that all the others follow.”

Listen to the article on Blog Talk Radio, read by Gloria Lemay
http://www.blogtalkradio.com/waterbirthinwoman/2010/05/28/pushing-for-first-time-moms-with-gloria-lemay

Update Feb 2014: Link to article in the N. Y. Times re length of second stage http://www.nytimes.com/2014/02/06/health/childbirth-study-sees-longer-labor-as-normal.html?_r=3

The new study suggests a normal second stage can take as long as 5.6 hours for women who get epidurals during their first births, and as long as 3.3 hours for those who do not get epidurals.

Added on Sept 15, 2016

“Secret info re upright positions for birth: We perpetuate the idea of vertical birth because, just maybe, if people think it’s important, a few women will be able to get out of that stranded beetle position. Don’t tell anyone, but even if the woman is doing a head stand, her mighty fundus will piston the baby out of her body. Just as a person knows how to have their daily poop or how to vomit. . . what position is best?. . . the birthing woman who is not instructed will find the right way to lean, bend and angle to get the baby out. Home birth attendants often observe that women stand and squat for first births but for subsequent babies upright positions will often be too intense. The multiparous woman will be on all 4s, sidelying or other non-vertical positions that help her to slow down the freight train (baby) that has suddenly dropped like an elevator through her vagina.”

Gloria Lemay

Castor Oil inductions

Inducing with castor oil isn’t safe. Once swallowed the castor oil is hydrolized by intestinal lipases to recinoleic acid which stimulates intestinal secretion, decreases glucose absorption and increases intestinal motility. Castor oil is used in lipsticks, too. Many women who can tolerate the oil quite well on their lips get a reaction on their mouths if the oil converts to recinoleic acid. My question to a midwife who says castor oil is not absorbed is ‘Would you please provide me with references for that statement’.

It’s not so long ago that birthing women were given soap suds enemas (high, hot and a helluva lot) because someone started a rumor that soap was not absorbed through the colon. We know this is not true and that this black page in Obstetric history is best forgotten. Too many women have turned from saying ‘My doctor says’ to saying ‘My midwife says’. Take responsibility for your and your family’s health. It is fine to respect professionals but ask for references on everything you’re not l00 % sure of and use your internet to scope things out. There is so much crap that passes for science without anyone questioning it.

On the subject of all the women in a hurry to get their babies born: I was 3 weeks ‘overdue’ with my oldest daughter. What really helped me was that I had lunch with a friend at about 8 months pregnancy. Her son had been born 6 months before. When she saw me walk in the restaurant all hugely pregnant she said ‘Oh, Gloria, when I see you I miss my pregnancy so much’. I knew that one day I’d be saying that, too, so I made up my mind to enjoy it as long as possible and I’m so glad I did. Six months from now you’ll be wondering what the rush was. I worry about women taking castor oil because you also give your baby castor oil when you take it through the gut. This means the baby will get diarrhea and pass meconium, too. Then you’re into all the transports for meconium.

— Gloria Lemay

Feedback to Midwifery Today Magazine:

Thank you for including Gloria Lemay’s comments about castor oil [Issue 4:26]. We all want to see women empowered to make truly informed choices about their care. Unfortunately, most birthing women tend to simply trust that their birth attendant will know what is best for them. The danger of this occurring in a homebirth environment is no less than in a hospital setting and may in fact be more insidious, because while so many of us distrust the obstetrician’s medicalized approach, the homebirth midwife is regarded as especially wise in the ways of birth, as well as unintrusive and noninterventive. The definitions of these last two terms are of course relative, and midwifery, just like obstetrics, is based in traditions that are not always safe or beneficial.

I came to understand this first from experience. My labor was not difficult, but it was longer than average. My midwife encouraged me to drink castor oil to speed up the process. Eager to escape the tedium of labor and to see my baby, I agreed. It was a huge mistake. The stomach cramping was severe and compounded the pain from my contractions, which were now coming fast and furious. Back labor was very painful [in subsequent births], yes, but do-able; my castor oil labor was a tortured hell. Now I know that I was putting my baby at risk as well. I would have much preferred the tedium of a long labor.

Linda Hessel
Peoria, OR

Why birthing women take an advocate to the hospital

This oped piece was published in the Canadian Medical Post. Read my reply to the doctor at the end of the item. Gloria

February 18, 2003 Volume 39 Issue 07

OPINIONS / OBSTETRICS

OPED: The unpopular science of birth
We have to incorporate the connection ‘natural’ healers such as doulas
make with patients—without abandoning science

By Richard Gruneir

I’m beginning to think everyone but you and I are crazy, and I’m not so sure about you any longer.

I practise obstetrics. I know you are already questioning my sanity but I can assure you I remain moderately sane most of the time. But as Bob Dylan sang, “The times they are a’changin.’ ” What is going on around me is putting pressure on my tenuous hold on normalcy.

Everyone who has had a baby or knows someone who has had a baby, or even watched the scene in Gone With the Wind where the baby is birthed, thinks of herself as an expert on the subject of obstetrics.

I have attended about 7,000 pregnant women and have a good idea how the complicated collection of things that must come together in just the right way for there to be a good outcome actually come together. I still get a big kick out of seeing the “munchkins” show up. Truly a marvellous event.

What scares me is that the experts seem to be taking over. (See two
paragraphs above for who is an expert.) And they all purport to support something called the “natural way.”
I have seen the natural way and am pretty sure the women deep in the hinterlands of developing countries aren’t thrilled to have it so
natural.
Natural includes experiences that filled the obstetrics textbooks,
including dead babies, dead mothers and everything bad in between that can happen to both of them. These things are usually preventable if someone with skills and knowledge and understanding is there to help. Natural is what our grandmothers and great-grandmothers had here in Canada when only 30% of their babies reached their first birthday.
Off-hand, I was unable to think of anything natural around me that isn’t today considered pathologic. The great public health initiatives of the early 20th century intervened in the natural processes and life
expectancy skyrocketed. The two most important are likely water
purification and vaccination programs.
Just think about Walkerton, Ont., and what happened when the basic water purification system broke down. A substance everyone needs daily went from being safe to being deadly.
Some will argue water without contamination by civilization was clean to begin with, but that’s not true. Animals in the forest deposit parasites in the water that can find a human host not in the normal life cycle of the parasite (Beaver fever anyone? A great Canadian favourite).
Seen any smallpox, diphtheria, pertussis or polio lately? Ask your
mother what these epidemics were like when she was a kid.
So where did this worship of “natural” come from? What prompted women who otherwise seem intelligent and motivated to have good outcomes to trust helpers who are often uneducated, untrained and unlicensed with their health and the health of their babies? Where did all of these expensive helpers come from to give “natural treatments” to their “clients”?
When I say expensive, I really mean it. Apparently, doulas (a term from the Greek to describe a helper of women in labour) in the Toronto area are paid as much as $2,000 to help with the deliveries. The job requires being a coach, back rubber and supporter. The doctor who assumes all the responsibility for whatever happens gets only $340 in Ontario.
When I say uneducated I mean that the training course to become a doula is basically only a weekend, some reading and spending time with another doula during a delivery or two.
And unlicensed means no controlling body. Even your gardener is licensed to use pesticides. And bad or uninformed advice during labour and delivery can be as deadly as the incorrect use of poisons and pesticides.
The most incredible thing is that this “natural” approach trumps doctors and nurses. When did we become the enemy? When did it start to appear to our patients we didn’t have their best interests at heart? What did we do to lose our patients’ trust?
The only thing I can think of is that we are seeing an attempt to regain control. The white coats are much too scary and too much in a hurry to be viewed as empathetic and part of the process rather than just as controllers and disinterested observers.
We are going to have to slow down and reconnect with the mothers.
Maybe the real solution is just to act natural.
—Richard Gruneir is an ob/gyn in Leamington, Ont.

OPINIONS / OBSTETRICS
In response to:
OPED: The unpopular science of birth

Dear Medical Post

I read with interest the OPED piece by Dr. Richard Gruneir in which he
laments the rising trend of patient advocacy in obstetrics. (February
18, 2003 Volume 39 Issue 07) This obstetrician wonders why women in his community are spending up to $2000 per birth on a doula and asks the (probably rhetorical) questions:

“When did we become the enemy? When did it start to appear to our
patients we didn’t have their best interests at heart? What did we do to
lose our patients’ trust?”

These are truly valuable questions because, in examining them, some
solutions to the rising cesarean rate and malpractice insurance rates
might arise. Physicians have lost the trust of childbearing women
precisely because of the attitude that Dr. Grunier displays when he
makes the statement: “I have seen the natural way and am pretty sure the women deep in the hinterlands of developing countries aren’t thrilled to have it so natural.” By painting the desire to give birth normally as backward and
ignorant, he shows that he has no clue as to the sexual, spiritual and
social importance of the birth of a child in a woman’s life. This is
the same denigration of importance that many physician’s placed on
breastfeeding at one time.

Modern women cannot wait until some
“scientific” randomized controlled trial tells them that having their
abdomen sliced open is horrific. It took 50 years until we got the
“science” that told us what we had already known
instinctively—episiotomies are horrific. The science is coming that
will show beyond a doubt that epidurals hurt women and babies, breech babies are best born vaginally without medications, nitrous oxide is harmful to babies’ brains, learning disabilities are related to vacuum extractors, routine Vitamin K administered at birth does cause heart disease in later life, ultrasonic non-ionizing radiation does produce cellular changes in the fetus and the ova, etc, etc, etc. One day all the physicians practising today will do a mea culpa about the harm they have caused childbearing women and babies (or as Dr. Grunier prefers–munchkins). Meantime,
Canadian women cannot wait for the “science” of obstetrics to tell them what will hurt their children today. Dr. Grunier is correct in thinking that the rise of the doula is a sign of the mistrust women have toward those who used to have dominion over their births.

Gloria Lemay,
Vancouver, BC
2002 Recipient CHOICES Women’s Voice Award
1997 Nominee YWCA Woman of Distinction Award
Advisory Board Member International Cesarean Awareness Network
Contributing Editor Midwifery Today Magazine

Top 10 Reasons to Have a Homebirth

Top l0 reasons to have a homebirth
~by Gloria Lemay

10. To test the theory that “Not even the most doting mother can stand the voice of her two year old at 8 centimeters dilation”.

9. To enjoy the sounds of an electric air compressor inflating the fishy pool at 3 a.m.

8. To make all your girlfriends jealous when you tell them you made love to your hubby as soon as the midwives left.

7. To avoid having to jam those puffy feet into a pair of street shoes in order to go to the hospital.

6. Because you are a selfish, fanatical woman who only wants to have a big orgasm and you don’t really give a damn about your baby!

5. Because you want to see if it’s true what your homebirth friend told you that it would feel like your butt is splitting in two when that little forehead passes over the anus. (You’ve always been the curious type).

4. You want to see if those smart aleck midwives will really be able to keep your white eiderdown stain-free.

3. To prove to your mother-in-law that you are more stubborn and determined than she has ever been, and she better not mess with you anymore.

2. Because you take a perverse delight in other people running around with flashlights at 2 a.m. looking for addresses, while you stay cozy and warm waiting for them.

AND, THE NUMBER ONE REASON TO HAVE A HOMEBIRTH IS: (Can we have a drumroll, please, Paul?)

To throw a monkey wrench into the insurance billing departments and birth registration agencies so they have to come up with new ideas for dealing with something they thought went out of style with the horse and buggy.

Letter to Oprah, Dec 10, 2008

Dear Oprah,  you are so respected in the area of human rights.  I urge you to stop promoting SkinMedica face cream which is made from the foreskins of baby boys.  Also, you need to get Dr. Oz up to speed on the latest in male anatomy and physiology.  There is a film for medical students that he needs to watch on the website of Doctors Opposing Circumcision.  

http://www.doctorsopposingcircumcision.org/video/prepuce.html

Ending the circumcision of infant males in North America is a human rights movement that is gaining strength every year.  Please educate your staff on this subject and be a leader in standing up for those who cannot speak for themselves.

Best regards, Gloria Lemay, Midwifery Educator

Teratogens: Harmful to the unborn baby

Alcohol: Alcohol crosses the placental barrier and can cause fetal alcohol syndrome and permanent birth defects, especially if consumed in high quantities. Most organ development is completed a few weeks after the first trimester. Brain development continues throughout pregnancy and after birth. Exposure to alcohol any time during pregnancy will affect the baby’s brain. The harmful effects of alcohol vary with the stage of pregnancy and the amount consumed on each occasion. However, research does show that all types of alcoholic beverages have the same negative effects during pregnancy. Abstain from all alcoholic beverages if you are planning a pregnancy and while you are pregnant.

Nicotine: Smoking during pregnancy increases the risk of a baby being born prematurely and underweight. Stop smoking if you are considering getting pregnant; if you are pregnant, never smoke. Because of the health risks associated with second-hand smoke, avoid any smoky environments.

Caffeine: Caffeine crosses the placental barrier into the baby’s blood when you are pregnant or breast-feeding. Not only is caffeine toxic to the baby’s developing nervous system but it also interferes with iron absorption and the body’s ability to effectively use insulin. It’s best to quit caffeine completely but, if you must drink it, limit your caffeine intake to less than 300 mg in one day. (One cup of coffee contains about 150 mg of caffeine, one cup of strong black tea contains about 100 mg of caffeine, and one 355 mL can of cola contains 36 to 46 mg of caffeine.) Watch out for so-called “energy” drinks – that are high in caffeine. Energy drink manufacturers are not required to list caffeine on the drink label unless the caffeine is added as a separate ingredient. However, caffeine in energy drinks can be from natural sources, such as guarana or yerba mate, so the label may not tell the whole story about how much caffeine is in the drink. If you need a soothing cup of something warm, choose citrus, raspberry leaf, nettle or lemon herbal teas (two or three cups per day), soup or miso broth.

Medications: Illicit drugs, inhalants, prescription and over-the-counter medications, and even certain herbal products affect the unborn baby. Check with your midwife or pharmacist before using medications and herbal products. Buy prenatal vitamins from a reputable health food store and do not take more than the recommended daily amount of Vitamins A, C. and E.

Some artificial sweeteners: Aspartame, sucralose, and acesulfame-potassium are used in many foods such as soft drinks, desserts, yogurt, fruit spreads, salad dressings, chewing gum, and candy. The latest research shows that these products are very harmful to human health.

Fish and shellfish: Certain fish may contain high levels of mercury, which can affect the baby’s developing nervous system. Avoid swordfish, marlin, and shark. Limit your intake of tuna or salmon to two medium-sized cans of salmon or light tuna, one medium-size can of albacore tuna, or one fresh tuna steak per week. Avoid raw (e.g. sushi) or undercooked shellfish such as oysters, mussels, prawns (shrimp), and crab. These may cause severe food poisoning if contaminated by bacteria.

Milk and milk products: Avoid unpasteurized milk and cheese. This includes soft cheeses such as feta, brie, Camembert, blue cheeses, and goat cheese. These foods may contain bacteria called listeria, which are harmful and can be deadly to unborn babies.

Raw sprouts and unpasteurized juices: Use caution with store bought raw vegetable sprouts (such as alfalfa, clover, and radish) and unpasteurized fruit and vegetable juices, as these may contain bacteria such as Salmonella and E. coli. These bacteria can cause serious illness in pregnant women and the unborn baby.

Raw or undercooked meats, poultry or eggs: Undercooked meat, poultry, and eggs can contain bacteria and parasites that can harm an unborn baby. Be sure to cook ground beef and pork to at least 160° F (71° C), roasts and steaks to 145° F (63° C), whole poultry to 180° F (82° C), and eggs until the yolk and white are firm, not runny. Buy organic meat and eggs, they are worth the extra money.

Certain meats: Avoid meat patés, and all liver products because of the risk of listeria.

Prepared foods: Avoid ready-to-eat meats such as deli meats, patés, and hot dogs. Also avoid ready-to-eat dressed salads (e.g., potato salad or coleslaw) and packaged salads. These foods may contain listeria, a deadly bacteria. Monosodium glutamate, (MSG) used to season deli foods is a known neurotoxin.

Become an avid label reader in pregnancy and continue this practice throughout your child’s life in order to protect him/her.

Midwife’s Guide to an Intact Perineum

by Gloria Lemay

 

An intact perineum is the goal of every birthing woman. We love to have whole, healthy female genitalia. Many people consider the health of the vagina/perineum to be a matter of chance, luck or being at the mercy of the circumstances of the forces that prevail at the time of the birth.

 

Folklore abounds about doing perineal massage prenatally. No other species of mammal does this. Advising a woman to do perineal massage in pregnancy implies a lack of confidence that her tissues have been designed perfectly to give birth to her infant.

 

The intact perineum begins long before the day of the birth. Sharing what the feeling of a baby’s head stretching the tissues will be like and warning the mother about the pitfalls in pushing will go a long way to having a smooth passage for both baby and mother.

 

The woman will be open and receptive to conversations in prenatal visits about the realities of the birth process. Here, in point form, is the information I convey for the second stage (pushing):

 

1. When you begin to feel like pushing it will be a bowel-movement-like feeling in your bum. We will not rush this part. You will tune in to your body and do the least bearing down possible. This will allow your body to suffuse hormones to your perineum and make it very stretchy by the time the baby’s head is stretching it.

 

2. The feeling in your bum will increase until it feels like you are splitting in two and it’s more than you can stand. This is normal and no one has ever split in two, so you won’t be the first. Because you have been educated that this is normal, you will relax and find this an interesting and weird experience. You may have the thought, “Gloria told me it would be like this and she was so right. I guess this has been going on since the beginning of humankind.”

"Red (or purple) Line that extends upwards between the bum cheeks"

“Red (or purple) Line that extends upwards between the bum cheeks”

 

3. The next distinct feeling is a burning, pins-and-needles feeling at the opening of the vagina. Many women describe this as a “ring of fire” all around the vaginal opening. It is instinctive to slap your hand down on the now-bulging vulva and try to control where the baby’s head is starting to emerge. This instinct should be followed. It seems to really help to have your own hands there. Sometimes women like to have very hot face cloths applied to their perineum at this point. If you like the feeling of this, say so, and if you don’t, say so. We will do whatever you feel like.

 

4. Most women like pushing more than dilating. When you’re pushing, you feel like you’re getting somewhere and that there really is a goal for your efforts.

 

5. This is a time of great concentration and focus for you. Extraneous conversation will not be allowed in the room. Everyone will be silent and respectful in between sensations while you regather your focus. Once you begin feeling the ring of fire, there is no need for hurry. You will be guided to push as you feel like until the baby is crowning (the biggest part of the back top of the head is visible). All that will be touching your tissues is the hot face cloth and your own hands. It is important for the practitioner to keep their hands off because the blood-filled tissues can be easily bruised and weakened by poking, external fingers. This can lead to tearing. We will use a plastic mirror and a flashlight to see what’s happening so we can guide you. We won’t touch you or the baby.

 

6. This point of full crowning is very intense and requires extreme focus on the burning—it is a safe, healthy feeling but unlike anything you have felt before. You may hear a devil woman inside your head who will say to you, “All you have to do is give one almighty push here and it will all be over—who cares if you tear . . . just give it hell and get that forehead off your butt!” This devil woman is not your friend. Thank her for sharing and then have your higher self say, “Just hang in there. It’s OK. Panting and rising above the pushing urge will help me stay together, and I will have less discomfort in the long run.” Your practitioner will be giving only positive commands at this point, and she will be keeping them as simple as possible to maintain your focus. Typically the birth attendant’s instructions are “Okay, Linda, easy . . . easy . . . easy . . . pant . . . pant with me . . . Hah . . . Hah . . . Hah . . . Hah . . . Hah . . . Hah. Good, that one’s over. You’re stretching beautifully; there’s lots of space for your baby. This baby’s the perfect size to come through.”

 

7. You will be offered plain water with a bendable straw throughout this phase because hydration seems to be important when pushing, and you can take the water or leave it, as you wish.

 

8. Once the head is fully born, you will feel a great sense of relief. You will keep focused for the next sensation, which will bring the baby’s shoulders out, and the baby’s whole body will quickly emerge after that with very little effort on your part. The baby will go up onto your bare skin immediately, and it is the most ecstatic feeling in the world to have that slippery, crawling, amazing little baby with you on the outside of your body. Your perineum may feel somewhat hot and tender in the first hour after birth, and believe it or not, the remedy that helps the most is to apply very hot, wet face cloths. This is in keeping with the Chinese medicine theory that cold should never be applied to new mothers or babies. Women report that they feel instantly more comfortable when heat is applied, and any swelling diminishes rapidly.

 

9. When you push your placenta out, the feeling will be like that of a large, soft tampon just plopping out. It is a good feeling to complete the entire process of birth with the emergence of the placenta.

 

When a new mother has an intact perineum, she recuperates faster and easier from birth. I like to twist a diagonally folded bath towel into a very tight roll and coil that into a ring for the woman to sit on when breastfeeding. Lovemaking can resume whenever the couple is ready; it feels good to use a little olive or almond oil as a lubricant the first few times.

 

Originally published in Midwifery Today Magazine.

Optimal Use of Language for Creating Birth Outcomes

The only way we can undo the mass psychosis about childbirth in North America is to invent new language and new images. Midwives must make a conscious and disciplined effort to become “speech magicians.”

I train my clients to ask for what they WANT rather than what they DON’T want. For example, the client doesn’t want an episiotomy = the client wants an intact perineum. Or a client says “I don’t want my baby taken away from me! = the client says “I want my baby ‘Velcroed’ to my skin from the moment he/she is born.” All my notes in my chart are what the client WANTS, not the “Don’t” instructions. This way, I am constantly picturing the image of what is wanted and so are my assistants. When everyone is picturing “Baby Velcroed to skin” then it happens. This technique is particularly effective at hospital births.

Another good way to create what you want with doctors is by using “indirect” hypnosis. For example, the doctor is starting to fidget as the baby’s head distends the perineum.

blunt/sharp scissors

He reaches for the scissors and you know he’s getting ready to do an episiotomy. So you speak to your client, not to him, by saying something like “Linda, you are stretching beautifully; there’s lots of space for your baby to come through. Everything is healthy and normal — there’s lots of room to stretch even wider. Breathe some oxygen down to your muscles.” Everything you are saying to your client is really intended to chill out the doctor. Speaking to him directly is less effective (it makes him more resistant to your message) than speaking obliquely to him through your words to the mother. Once the doctor starts taking deep oxygenated breaths down to his muscles, you’ll see him put down the scissors.

You’ll notice that Dr. Odent does word magic, too. He talks about the “fetus ejection reflex” and the “ancient reptilian brain.” I don’t think anyone has ever located these things in the physical universe, but they are most useful concepts and ways of languaging that lead to better births for women and help undo some of the fear-based pseudo science that passes for obstetrics.

first published in Midwifery Today E News June 12, 2002
Volume 4, Issue 24

Newborn death following circumcision

British Columbia parents lobby against circumcision
CBC News 2004/02/11

The parents of a newborn who died following circumcision surgery are pushing for hospitals to inform patients of the possible dangers associated with the removal of foreskin.
Brent and Tanna McWillis’s month-old son Ryleigh died in August 2002 after he suffered severe hemorrhaging two days after he was circumcised at Penticton Regional Hospital.
 
The parents were told that Ryleigh would experience some bleeding, but they didn’t realize how much was too much. A coroner’s report concluded that post-operative instructions could have been better defined and the hospital has since produced a more descriptive pamphlet which it hands out to parents. It has also introduced new post-operative procedures.

Ryleigh’s death renewed debate over male circumcision and also caught the attention of a Seattle-based group called Doctor’s Opposing Circumcision.

One of its members, lawyer John Geisheker, wants circumcision banned globally, but in the meantime, he’s willing to compromise and has asked infants be kept in hospital for one day following surgery.

“We would like to see there be no outpatient circumcisions, because those are the riskiest ones,” said Geisheker. “The parents, although they may be solicitous and loving, are not medically trained.”

Three decades ago, about half of all Canadian boys were circumcised shortly after birth, compared to 20 per cent today. Some doctors deem circumcision medically unnecessary and refuse to perform the procedure.
  ated Sept 2015: Link to this story no longer active so I’ve removed it. Gloria Lemay.

__________________________________________________________________________________________

This story from 2004 underlines the danger of boys dying from complications of circumcision.  It’s estimated that 200 baby boys die every year in the U.S. from complications of circumcision.  The reporting of the death might not mention circumcision so it’s difficult to get accurate statistics.  What begins as an unnecessary surgery on the penis can end up as “shock”, “hemmorhage”, “infection”, etc. on the death certificate. 

Because Ryleigh McWillis’ death happened in my province, I have followed the story carefully.  Of course, many other boys have died here due to complications of circumcision but this story came to light because someone in the hospital called the press.  This is the power of the education movement that we have undertaken–when enough people learn about the horror of circumcision, even hospital personnel will speak up.  Once the hospital staff stops covering up what’s going on the procedure will end.  Ryleigh’s parents knew that he had too much blood on his diaper.  It’s natural that parental instincts click in when red blood is soaking through a diaper.  They took their baby back to the hospital and the staff rebandaged him and reassured them everything would be all right.  It wasn’t, and this healthy, normal boy lost his life.  Reading the coroner’s report about what happened when they took their baby back to the hospital the second time when he was near death is absolutely horrifying.  The staff could not figure out what was wrong with him and wasted precious time thinking he might have an infection. 
http://whttp://www.circumstitions.com/death-exsang.html

One of the scraps of information that has come my way about circumcision is that there is a rule in Judaism that if two of your sons have died from circumcision, you do not have to circumcise your third son. 

Today, there is a rising concern over the increasing resistance of bacteria to treatment by antibiotics.  Methicillin Resistant Staphylococcus Aureus (MRSA) is not only a hospital acquired infection but is now also reported in the community.  Boys have died from MRSA infections secondary to circumcision.  Newborn boys have died of herpes infections after being circumcised as well.

Midwives, doulas, doctors, nurses, and hospital employees have a duty to the public to become “whistle blowers” when they see death and injury linked to circumcision.  Pick up a phone and call the newspaper, anonymously if necessary. Shining the light of public scrutiny on this human rights violation will relegate circumcision to the “Dark Ages” of history where it rightly belongs.