Catching up

I don't have any illusions that I'm going to write on any sort of regular basis, but it feels good to check in now and then.

I have shifted from sort of dreaming about midwifery to actually moving toward it. It's funny how profound and how simple this journey is- I've seen so many other doulas take it and it always felt so magical, and mundane at the same time. I've known a lot of doulas who have dreamed of becoming midwives, and I have only recently fancied myself one of those with any real seriousness. I feel like I'm joining another set of ranks in between the worlds of the lesser liabilities and responsibilities, to the greater ones.

Something that I am really grateful for as I march forward is number one, the length of time I spent doing doula work before I started to pursue midwifery. I've been able to in a huge, hands on way, really explore who I believe myself to be in the birth space, letting go of attachment to outcomes, separating myself emotionally from my clients and cleaving to them in appropriate ways, having boundaries (I am still working on this, but probably always will be, right?), and so much more. It is not just a passion for women, birth and babies that brings me to midwifery, I feel like I had to really develop a strong, mature sense of self before I could start down this road.

Submitting to a woman in labor is one thing- letting go of ego, of attachments to what I want her to do, or what I want her to experience - submitting to a provider whose decisions I must not only quietly accept but then also execute, is a different level. Thankfully I'm not terribly challenged in this department - I have the good luck to be working with midwives I know well and whose protocols I feel comfortable with- but I know this will not be true always. I remember being a fired up doula who was totally ready to stand in front of a provider and say STOP! I find it funny now, it's like looking back at my own doula-childhood.

Recently I was at a birth where the mom had some complications and we had to move swiftly to support her. It wasn't anything critical but you never know until you look backward- we were a fluid team that moved easily together and I felt absolutely relaxed. I reflected later that it was because I trusted this midwife to know what to do, and that we would have what we needed to care for her until EMS arrived if we needed them (we didn't). I also realized that I trust myself too - even in those moments of HOLY SHIT WTF IS PITOCIN!? where my mind goes absolutely blank for a fraction of a second, I know what is needed, I know what to do, I have the experience at births to know what is coming down in the next two or three (or more) steps. I don't expect that I will always feel so relaxed, but right now, with the births I've attended as an assistant, I absolutely hunger for more. I also realize that part of feeling so relaxed is that I am not the provider making the calls on what must happen next, I am simply doing as I am told, for now.

It is challenging to try to sort out where, as a birth assistant, no longer 'just' a doula, now on the leading edge of midwifery with more responsibility, more at stake - to get support and process these things. I'm wishing for a community of birth assistants like I have as a doula with my colleagues, and I also am grateful it doesn't exist at the same time. It feels good to cleave to my midwife and to my one or two friends who are on the same path I am- to not have to process everything out loud/in public.

Just rambling- I feel like I forget how to write sometimes and while this may be disjointed it feels good to just write a little.

The Red Hat of Midwifery

I remember when I want to the CAPPA conference in my town many years ago and saw Linda Smith, RN talk about breastfeeding. She had her conference talk and when she couldn't resist chiming in with her own personal opinion, she'd slap a red baseball cap on her head so you knew the difference. It was charming and clarifying and it's a concept I've used many times since then.

One area that I try hard to never wear a 'red hat of opinion' on is my doula work. It's hard sometimes; I see what the client wants, and I see what she's asking for, and being objective, I see the difference in those two things. I ask lots of questions and when clients ask me, "What would you do?" with that serious look on their faces, I know that they weigh my opinion heavily, and that my response will not just be casually catalogued with the opinion of the woman who does her nails. Like it or not, I'm seen as a woman wise to the ways of birth, wise to the ways of navigating providers, and myriad other facets of what we do when having our babies. I'm going to be heard as an authority. I have to take that really seriously because it IS serious.

When she asks me this question, "What would YOU do in my situation?" I remind her that what I would do is based on my own values, my own experience. It is not necessarily what anyone else would do. Also, what I do may not be appropriate for her situation. Last, I do not have to live with her choice- she does.

Sometimes she'll continue to press me, "I know, I know, but if I was your sister, what would you say?"

I care about my clients and being human, I of course also have this urge to share my opinion that is hard to deny- but it's SO important that I do exactly that.  If she presses I tell her pretty directly - "I'm not going to tell you what I'd do. I'm here to help you figure out what YOU need to do. What do you need to know right now in order to make this decision?" I have found that shifting it back toward her turns the conversation away from me, and toward something she can actually use.

Now I'm working closely with a lovely midwife - working hard to be a great assistant and soak up everything I can learn in the meantime. I'm navigating a new world and one where (the midwife's) opinion is expected and offered to clients, alongside support, encouragement, and trust in herself. I'm finding that I have to literally take the Red Hat of Midwifery off of my head when dealing with my doula clients. Because the worlds are so very different, it is a conscious choice I have to make to go back to questioning, rather than answering (not that I'm giving any information to midwifery clients, I'm not, but I don't have to be restrained in my own mind the way I do with my doula clients.) Basically, if I'm not in the right head space, the lines get blurred VERY quickly.

I was talking to my friend about this and I wondered if this was why some doulas struggle between their desire to be midwives and their power as doulas. It takes a lot of restraint, as I'm learning things, not to want to share what I'm learning! I would be *harming* my relationships with my clients if I wasn't clear.

I can see where, when doulas are offered the chance to feel a cervix, check heart tones, etc. that it is so difficult to say no. I've been offered, even implored, to check and I've had to say no. It was VERY difficult because I desperately want to learn these things! However, I knew that no matter what I said, they'd weigh my interpretation very heavily and it was so important that I not disrupt her own knowing with what would have largely been a really inept guess. Imagine if I'd thought she was barely dilated and it turned out she wasn't, and we left too late? Or the opposite- I thought she was further along than she was, we left and found out that she wasn't nearly dilated and we'd gone in too soon, thus exposing her to increased interventions or having to choose to leave? No thanks!

As I move into 2011 I'm finding both feet firmly in the midwifery world- I'm not asking for doula client this year like I did last year - I am accepting what comes, but I am most excited about sitting at the feet of the midwives who invite me along, and holding space for these mothers as they teach me too, in their own knowing, their unfussy-ness, their tentative steps into the unknown with bare feet and round bellies.

I will say that having been so conscious about my professional boundaries, and so serious about not crossing them, has liberated me to become a doula strong in communication, intuition, and heart - things that I know will serve me brilliantly as I inch my way toward midwifery.

No longer an urge

Today is the day that my daughter was born by urgent cesarean at 35 weeks for fetal distress, three years ago. She was a teeny, tiny 4lb 7oz bundle brought to me and stuffed into my neck where I couldn't see, but only kiss her sticky cheek.

Every year around this time I think back to her birth and I find that the further I move away from all of my birth stories, the less I feel the need to relive them. There is an important healing that happens every time we tell the stories of something that changed us; we reap information and healing and integration every time the story is told.

I started to share my birth story, and I realized that I didn't really need to anymore. I don't need to write it out, I don't need to relive every terrifying moment. It was scary, and it was one of the hardest, most courageous things I've ever done. I did it, and it's done.

When I look back at the births of my sons, at the time I was very upset and even traumatized. I look back and think that I had pretty good birth experiences, all in all. A lot of my suffering was my own creation- hanging on to an outcome to the bitter end as my plans were decimated by pre-eclampsia and a baby who needed to, but was just not ready to come out. Not having the knowledge about what I was agreeing to when I asked to be induced - these were what I used to call mistakes, and now I just consider it a part of their stories. No more urge to look back and judge myself. I realize fully in my soul that I have only EVER done what I knew best in the moment to do, and that bitchy nurses and impatient doctors and doulas with bad breath were all just players in my story. They weren't what defined it unless I empower them so.

Who was *I* in those moments? How did *I* show up - for myself - for my birth - for my babies?

I don't mourn for a birth I never had. I do wish I could have gone into spontaneous labor at least once, but then I remember that my regrets are rather privileged in a world where women give birth to long dead babies with no one at their side, on hefty bags in bays of other women also laboring, in facilities lacking even basic supplies. I didn't get to go into spontaneous labor but knowing that I had a really great chance of surviving my births, that my children had a great chance at survival, that I had every tool at our disposal should it be needed, that my pre-eclampsia was caught early and not when I went into seizures giving birth - it humbles me.

I am not minimizing my births by comparing them to someone else's awful story; these are my stories and I claim them fully. I claim the Divine Mystery that tells me that no matter how well you plan, something that will surprise you is up ahead, I claim full responsibility for the choices I made, and I claim the lessons I've learned because of my births.

This is Eidie's gift to me today! Happy birthing day to us both. May her uterus never be cut and she birth in the arms of those who love her, should she decide that making babies is something she wants to do. ;)

Well rounded midwife

I was chatting with a couple of my midwife friends this morning at a birth we were at. I really enjoy and value these discussions- I am learning that I yield something completely different from talking in person with these topics than when I'm online. (Not the least of which is that I am usually easily understood and rarely ever have to explain myself or be defensive of my position, but I digress..)

Going back to a discussion I had with one of these lovely midwives about my choice for schools and how I originally thought that I'd want a school that was in alignment with my values about birth. As soon as the words left my mouth I knew they weren't what I really wanted. Why do I need to go to a school that just affirms what I already know? What I really want is to be challenged by my education. I don't want to be bored or agree with most everything. I want to have my boundaries pushed. I want to work with wide spectrums of people in different communities, countries - I plan to work hard not to develop my position but develop my sense of self in the world, my sense of community. At this moment, knowing what I know today, that feels like a healthy approach to midwifery.

A friend and I had a discussion about whether we'd take VBACs once we were practicing. Her position at the time was that you couldn't call yourself a midwife, and be pro-birth, if you didn't take VBACs and asked me if I would take them. Considering my last birth was a cesarean my own response surprised even me. I said I didn't know. I don't know who I will become through my journey. I've met more than one midwife who is in support of say, HBAC for example (homebirth after cesarean) but who has only ever experienced uterine ruptures and serious outcomes when they've attended them. They had the wisdom to know they did not need to bring their fear and concern to these births and have elected not to attend VBACs at home. It isn't anti-birth or anti- woman, it's pro-sustainability of practice, pro-sanity, and even pro-birth/woman/etc. for the midwife to know what her own boundaries are. Sounds healthy, if you ask me.

Thoughts after SQUAT Camp.

I went to a few sessions at SQUAT camp. Haven't heard of SQUAT? You should read it, and then you should email the people who write it and find out more about them. You should think hard on the topics they're raising because I know I am.

It's time to question- I have been feeling dissatisfied having the same old arguments about the same old stuff. Not to say these things aren't valid, but I just feel that for me, it's time for something bigger, and deeper.

I realized lately that many conflicts are more around semantics rather than separate issues and isn't it lovely that we have the luxury of time to argue the better way to give loving care to women? I think it is- but I also wonder how the hell we get to the next level. Where are the visionaries? I suppose we all are visionary in our own way, and some visions must be huge, and they are lifted and carried by the smaller visions- and all are equally important. I am hungry for big visions and big shifts and big work, and big love.

Today I went to a session where we talked about abortion, doulas, and midwifery. We heard from someone who has worked in an abortion clinic for a long time with a big heart and a lot of passion - the holes are many in providing women good care. It's so parallel to birth- a huge medical event, consent forms, bright lights and protocols. Gone are the days when women went to their midwife with questions about how to terminate their pregnancy - we now go straight to our friends, and then straight to the clinic.

We've lost the knowledge to manage our own fertility- talking about cervical mucus is not something you do in polite company, generally. Often times even when women were frustrated with their birth control options they weren't interested in learning fertility awareness - I suspect there is something too 'real' to having to touch your vagina every morning, examine the mucus that lives there, chart it all. We've grown so distant from our own bodies that even this basic fundamental knowledge that every person should grow up knowing is saved for 'crazy and weird' women.

I've been thinking about offering abortion doula services to women and it's something I feel strongly about. However, I admit I'm afraid to advertise this service in connection with my birth doula services. I'm afraid to be targeted, I'm afraid to lose clients. I know I will find some solution that works - but for now I need to sit in this discomfort. It's been easy to be a doula and be relatively non-political, other than the occassional stirring of the bees nest. Who doesn't need a good sting now and then to remember they're alive, right? This is much bigger- people are murdered for working in abortion clinics. I feel no reservation about working through the clinic but taking it into my own hands and advertising that I offer these services- attaching a price to it? It does scare me a bit.

It was interesting to sit with women who are holding a vision of midwifery that I thought I shared until I realized I didn't. I'm unsure where to go with it. We talked about midwives teaching women how to do their own PAP smears, how to manually extract menstruation, and how acupuncturists might have something to say about non-surgical abortion techniques. We talked about how women have to go onto the internet and piece-meal an herbal regimen together in order to achieve an abortion in the privacy of their own homes, taking risks unto themselves and not thoroughly understanding what they're doing.

How can we retain this knowledge- I think it's at a point now where it must be recreated. Our history has been burned out of us and we're working hard to retain what we can salvage from those who came before us. Political issues like scope of practice and licensure and lawsuits and legality of midwifery, oversight, and so many other things muddy our vision and I know in my case, I did not SEE what I was forgetting about being a midwife. The continuum is not just from family to life, but from life to death as well. We are the witnesses and we hold vigil, and we are the ones that are invited to be present at life's pivotal moments. We hold the stories of families from beginning to end, and to back to beginning.

I still don't know who I want to be as a midwife but I know that I do not want to stand on the shoulders of the midwives who burned before me, who were jailed before me, who lost their families, their children and their lives before me, so that I could attend families in a way that is convenient and easy for me, and compromising for them.

What does it all mean? I don't know yet.

Letter to New Doulas (Part 1)

Congratulations, you've joined an amazing Sisterhood (and in cases of the elusive and rare male doula, Sibling-hood!) There are a few things I want to tell you to help you along in your journey. Some of these things are questions I've heard frequently from new doulas and others are just bits of wisdom I want to pass along that I've learned along the way.

First, let's chat about the issue of charging money. I remember when I was a new doula, the idea of asking someone for what I thought was a significant (although reasonable) amount of money for my services gave me the trots. My very first client was a friend who insisted on paying me $300 which I really appreciated but did not feel I deserved. I tried hard to say no because I felt guilty taking her money when she was letting me be at her birth..... wait a second... did you catch that? I felt guilty for asking for money for my services because this client was doing me a favor by allowing me at her birth. Was she the one providing the service, or was I?

If we don't charge for our services, whether you get paid in cookies, yard work, web design, or greenbacks, we can set up a really funky dynamic between client and doula. I'm not saying it happens every time, what I'm speaking specifically about is new doulas who do not yet (sometimes) know their value - who are afraid to ask for what they have a right to receive - who do not trust that what they offer is worth something significant. We carry this energy into the birth space with us and sometimes the dynamic that happens is that the doula is not a trusted guide, she is a guest in the space. She brings a subservient energy to the space that is not the same as being in service to the client, it is more of a 'thankyousomuch for letting me be here I'll try not to disturb you too much' energy. Asking for money takes the 'favor' out of it, it allows for emotional distance without the distraction of the money issue hanging around in the back of our minds. We're more adventurous in our solutions and we speak up more when the energy is balanced, and who benefits? You and the family, both!

Women in birth need to feel their support system is intact, strong, and without conflict. If we are conflicted (and maybe not consciously, maybe it's purely emotional) about our role in that space, the mother will be too. She will not call on our counsel, or trust what we have to say if we do not demonstrate confidence.

(I learned a long time ago that if you say something with confidence, as if you know what you're talking about, people think you do. It's definitely a double edged sword so I charge you to only ever use this power very rarely and only for good! You know, like when someone asks you a question you can't easily answer and you're in front of a huge group of people... yeah. Don't lie, wing it, but with confidence!)

In my own experience, I've had clients hire me who needed free services. They called me when I asked them to check in after their provider appointments, kept me in the loop, sought me out when they had questions or concerns, honored our barter arrangement if there was one, wrote referrals after the birth and were generally super grateful and wonderful to work with. It felt balanced to me.

I've worked with other clients who were in situations where they were accustomed to receiving free services from others and just didn't generally value what I was giving away for free. I was one in a long line of people giving something for free. There was no accountability, the communication was sticky, my time and offering generally were just not honored. I felt more like I was giving away some kind of charity which did not feel good to me at all, and which I had to work through during our entire time working together. Fortunately this has only happened a couple of times before I figured out what was going on and pledged to myself to approach this differently.

What I learned was that I didn't want to take clients based on if and what they could pay me, I wanted to take clients based on whether or not we had a strong desire to work together, and the chemistry and excitement about each other to have a good relationship. I figure money will work itself out- when one client can't pay me, I know the next one will help pay for them both.

We honor the parents by asking them for money. What we are saying to them is that we know that they (like everyone) has something to offer - we all have gifts. We honor ourselves, too. Take into consideration that you spend this, and maybe more, to just say YES to a client:

* Gas for the consult, gas in your car at all times if she hires you
* Money on hand for child care, babysitter, day care
* Money for food for yourself during the birth, change for machines at the hospital, etc.
* Parking fees, ferry charges, toll booths
* Mileage on your car is reimbursed by the IRS now at I think .51 per mile, so imagine that is an expense of wear and tear on your car until tax time arrives and you can get 'reimbursed'
* Let's not forget your doula training expenses!
* Time off from work for you or your partner to attend the birth, allow for recovery time
* Printing of business cards
* Website hosting, design, maintenance
* Birth bag items, educational items

The list can go on from there, in even finer detail. Now look at this list and think about numbers, and we're not even talking about the reasonable hourly wage you could make putting some of this stuff together. That's a FAT sum of money. Obviously you're not paying for all of this with every client but each client helps to chip away at this larger sum. We didn't go into this work to also go into debt!

The last thing I'll say on this is that there is something Divine about being honored with reciprocal energy after you pour yourself fully out on another human being. Receiving that payment feels good- it honors you AND it honors your entire family for the gift they're giving by sacrificing time with you so that this client can have you there. Being a doula is family work- we work for families, and it takes contribution from our families in order to allow us to do it. Money coming in helps to balance the energy that you're pouring out.

So please, charge something! Being certified has absolutely nothing to do with it. No matter what your trainer said, or what you think she said, no doula organization requires you to work for free until you are certified (and if I am wrong about that please enlighten me and I will amend.) If you want to charge lower rates when you start out, great! Charge $50 if that feels good to you- push yourself on this one. You will not be in your comfort zone for a while and that's okay. The idea is to get yourself trained to ask for money and to feel good when you receive it, and especially for us women, sometimes that's something that takes time. While you're pushing yourself, be creative and offer to barter, offer clients to pay you in other currencies. I can't stress the importance of a good referral, or a letter of reference. Invaluable!

Part 2 to follow, thanks for stopping in. :)

Singing to the choir

I was in a meeting recently with some people I'm working with to start a food coop here where I live. I raised the point that we've made a grand effort to raise awareness among those folks who would be most interested in having a food co-op, but that it's time now to start pushing those boundaries and speaking to people who might not necessarily be interested in our message off the bat. Let's make it interesting, let's make it rewarding for them to get involved. It feels like a next-stage for us and I am excited to see what ideas we'll come up with around this.

I remember when I first became a doula, I had this fantasy (that quickly burned off once I started working in the 'real world' of birth) of getting a group of doctors, midwives, doulas, and nurses together to start really talking about giving the best care for women, rather than this territorial thing that happens. I think over time I learned that those in charge gain nothing by entertaining those who work against them being in charge- in other words, what would drive an obstetrician to take seriously the thoughts of professionals from other perspectives? If you don't have to change, you don't. No one is forcing anyone to look at what they're doing another way, and considering they have the market on 90% of the births, it's safe to say they're in a position of power.

I was recently reading the Midwifery Today which talked about birth as a human right, and then was looking at the photos of Ricki Lake visiting the CIMS Forum. Almost every face was female. I thought about the advocacy that I have been a part of, witnessed, supported over the years - and while I could list many women, there are only a few men whose names rise to the top.

This seems so obvious now, I almost didn't write about it, but isn't this another issue of singing to the choir? Granted, by no means have we reached critical mass! The choir isn't necessarily singing the same tune, but once we reach that place, it seems that the next phase of things is to convince not necessarily the obstetricians, but MEN in general, that birth is important, that women are important. It seems to me this issue isn't about birth at all, it's about the value this country places on women in general.

I'm tempted to call it a feminist issue but it truly is about human rights- by diminishing one gender, we diminish both. It is an issue for men as well as women - both men and women, both tiny infant boys and girls, are suffering in our current system. We are wedging babies out before they're ready, cutting open their mothers, exposing them to infection, complications and death. We are traumatizing families as whole units- not just mothers. If a mother is wounded, her marriage is wounded, her mothering is wounded.

It seems to be about women but what we're missing is that it's about men, too. We need to be singing to THAT choir.

Our culture teaches men that they are powerless in the birth space. Their women tell them where to stand and where to look and what they can and can't say, they charge their men with protecting them in the birth space with no tools to do so effectively. As a culture, we emphasize the ineptitude of men on television, broadcast for all to see, the panicking father who races through red lights and basically freaks out and is useless in the birth space. We see fathers who are disconnected from their babies, we hear constantly about men who are 'deadbeat' (disconnected?) dads and our expectations of our menfolk sink lower and lower.

Why should men care about birth as a cultural shift? We have not shown them that we believe in their importance, their value and necessity. One family at a time we make this shift where a father goes from doubting and insecure to powerful and present and protective - and then we do not use that energy to our advantage.

Can we make this culture of birth shift without fathers on our side, loud and vocal, organized even? When we get our men on board on equal footing with us, learning with us and passionate alongside us, I bet something big starts to shift. I don't think we can fight this fight without them.