The Birth of a Calling

 

The following is a writing assignment–a personal essay–I wrote in my first term at Indie Birth Midwifery School

I come from a middle class family with both parents holding biology degrees. While both parents respect the laws of nature, they are also both heavily encultured in the idea of medical technology. My father, as a Type 1 diabetic, has survived most of his life thanks to the advances of 20^th Century medicine. This is the story of how I evolved past that type of thinking, and unveiled my calling to the art of midwifery.

I grew up hearing the story of my own birth: my mother laboured for 23 hours, and the doctor eventually delivered me with forceps, scarring my face under my right eye in the process. I grew up learning to see this scar as a physical reminder of the dangerous nature of birth, and the fortune of having modern medical care available to us.

When in my late teens, as midwifery was just being regulated in my home province of Ontario, my parents opined that home birth was ‘selfish’ and folks who have successful home births with midwives were ‘lucky nothing went wrong.’ In my first year of university, one of my roommates was studying midwifery, and I learned that midwifery was hitting the mainstream. If a university offers a four-year degree in midwifery, it would be unconscionable for them to set people up for disaster, so it must be at least a reasonable alternative to the medical model of birth.

For several years after university I didn’t think about birth. That changed when I became pregnant with my first child, Caleb. My husband and I had recently relocated to Singapore, a very modern and technology worshipping city-state. I knew I wanted as natural a birth as possible, but felt anxious about my prospects of achieving it. I spent nine months researching birth models and philosophies, and created a terrific plan for care—as gentle as was possible within a high-tech hospital. Although I had a very empowering experience, I began to realize from talking to peers that for first time mothers in developed countries, ‘empowered’ is not usually how women describe their births. This led me to my interest in birth advocacy and doula work.

From 2012 to present, with some breaks, I worked as a doula and childbirth educator. Upon moving to Macau, I had toyed with the idea of pursuing midwifery education, but had dismissed it because of the lack of availability of training programs in this part of the world. As doula work is disregarded as a profession here in Macau, the government will not grant me a visa to work, so I have spent much of my time reading, writing, advocating and counseling women about birth. More and more I realized that my passion for feminism and normal birth, combined with my specific personality traits and talents, would be better suited to midwifery than doula work. My reading and research online led me to discover a conference called ‘Healthy Birth, Healthy Earth’ happening in Findhorn, Scotland in September 2016.

Off I went, halfway across the world, with high hopes of attaining personal and

Early morning airport selfie as I set off from Macau-Beijing-London-Inverness-Findhorn

 

professional inspiration and fulfillment. The conference vastly exceeded my expectations on every front. While in one of many afternoon breakout sessions, Ibu Robin Lim said to a group of emerging Birthkeepers, “if it is a piece of paper that is standing between you and making a difference in your calling, then get the paper!” This was a lightning rod moment for me. I had been struggling against the rampant credentialism I faced in my adopted country, but I also knew at that moment I needed to do whatever it took to get my voice heard, so it can be used to help women on a national and global level, in addition to helping individual families. So while at that point I still had no idea how I might achieve it, I committed myself to following the call.

Midwifery, to me, is a community-building activity, a spiritual and ethical calling. Continuing on my philosophical evolution, I envision myself a driving force within the birth community in Canada, helping to bridge the gap between care availability and birth outcomes in the general population, and those among the remote and indigenous populations. Through the natural teenage process of questioning and coming into awareness of the biases that coloured my parents’ worldviews, I have been able to create my own ideas and philosophies about birth. These philosophies have been strongly influenced by my exposure to several different cultures worldwide as I have traveled with my family for my husband’s work. I look forward to incorporating all of this knowledge and exposure into my future journey as a midwife and positively influence the birth cultures that I encounter along the way.

Skin-to-Skin Contact: My Experiences

Gena Kirby of Progressive Parenting Network posted a short interview with Karen Strange, CPM and neonatal resuscitation educator, on the topic of skin-to-skin contact between mothers and newborns in the first moments and hour after birth.

 

Interview with Karen Strange

I have long been a believer and sharer of the benefits of skin-to-skin contact for both mother and baby. A few things that Ms. Strange said jumped out at me and reminded me of my own two births.

“The senses are meant for the optimal survival of our species.  When you interfere with that, it impacts us…in the way that we attach and care for our young. The most important aspect of (the sensory experience immediately after birth) is skin-to-skin.”

In the header image, that is me meeting my son Caleb immediately after his birth.  It is a moment that will forever remain firmly in my memory as I was supported to have a full sensory experience of him.  We had deep eye contact, and the smell and sound of each other as his warm wet little body relaxed on my chest.  It was a perfect moment that I wish every mother could experience after birth.

When my daughter Caitlyn was born two years later, we had a very different experience.  We both had some serious complications that led to her being born by cesarean while I was under general anaesthetic.  As a result, I did not get to meet her until she was about six hours old.

The first time I saw her, I had been wheeled into her treatment room on a gurney, as I could not move myself into a wheelchair yet, due to the pain from my surgery and previous illness.  I propped myself up on one elbow and reached out and felt her cool little belly.  She was under induced hypothermia for treatment of suspected brain injury, so she felt unnaturally cold and lifeless to me, and yet, the moment I touched her, all of my pain immediately vanished.  Reflecting back on that experience to me, I have marveled that if a simple touch with my palm had that effect on me (and it lasted for several hours afterwards), imagine what it can do for infants who have full body contact in the safest and most familiar place to them-their mother’s chest. It is the stuff of miracles.

“Whenever mother and baby go back together after birth (if they have been separated by circumstances), that is where the healing begins. It can occur an hour later, a few hours later, days..but what has to happen is: turning on the critical sensory needs of the brain, which lowers the cortisol levels, and the baby goes here (on the mother’s chest). And when the baby goes here, he will eventually feel safe.  ‘I made it. It’s over.'”

In the adjacent picture, my daughter was about 8 weeks old. She and I had had a very traumatic birth experience, and she had been extremely tense and clingy in the weeks after. Just before this picture was taken, we had spent about 45 minutes cuddling in a natural hot spring (in Moose Jaw, SK) and when we came out she just melted on my chest like a lump of butter. This was the first time I’d seen her totally relax.

To this day (as of writing this she is 2 years and 8 months old), her favourite place to relax is on my chest.  I imagine that because our birth experience left so much wanting, it may be some time before we are both fully healed into our birthright-level of attachment.  We will keep working on it, and I am so happy to have heard Karen Strange’s words on this subject.  When Caitlyn is there, I will be sure that I am open to hearing her and making sure she knows she is heard and understood.

Rebranding: New logo, New Name

A part of setting up shop here in Macau meant I needed to register a new business name in either Chinese or Portuguese, and it can’t have the words parenting, mother, pregnancy, birth, etc, lest I be judged as practicing medicine without a license, or qualifications in the medical field.  “Doula” is not a vocation recognized by the government, so for the purposes of registering, I am a consultant for a yoga and body movement therapy company, and thus Conscious Wellness, aka Bem-Estar Consciente in Portuguese was born.

I am thrilled to unveil my new logo, designed by Sarah Moreland of Chameleon Creative Design, whose patience and creativity made the process fun and painless.

I wanted to preserve the river and mountains landscape that spoke to me of the areas I’ve served in the Fraser Valley and here in the Pearl River Estuary, where Macau sits. Sarah took this image and feminized it, making it curvy like a pregnant woman, making the river delta at once symbolic of new life as a tree and also making the whole thing rather similar to the baby’s side of a placenta.  I really, really love it.  I hope everyone else does too!

Now to work out my website colours to match…coming soon.

Macau Birth Doula Plan of Action

So how DO we serve the underserved communities? I mentioned before changing from the inside out.

1. Education

What I plan to do here is to begin with English language childbirth education.  I am a certified HypnoBirthing® Practitioner and am beginning this comprehensive series this month.  I believe this will start to open people’s minds to the idea that birth does not mean submission to an authority figure.  A favourite Ina May Gaskin quote:

“Remember this, for it is as true as true gets: Your body is not a lemon. You are not a machine. The Creator is not a careless mechanic. Human female bodies have the same potential to give birth as well as aardvarks, lions, rhinoceri, elephants, moose, and water buffalo. Even if it has not been your habit throughout your life so far, I recommend that you learn to think positively about your body.” 
― Ina May Gaskin, Ina May’s Guide to Childbirth

This pretty much sums up the aim of HypnoBirthing®: your body is designed to give birth, and your attitude towards your birthing body will shape your experience of your birth.

2.  Community

I plan to bring moms together in the expat community to get to know each other and me, by way of facilitating a breastfeeding support group and a ‘newly born and nearly born’ group. This will expose them to my radical uncommon-to-this-part-of-the-world ideas about gentle and family-centred birthing, as well as allow them to discuss these ideas amongst their peers.  I see this as a golden opportunity to provide support and education to those who are unable or uninterested in pursuing my client services.  Also, they will learn that doulas aren’t all as portrayed in the media and entertainment. Most of us are quite sensible, pragmatic, albeit passionate, feminists whose egos and personal preferences stay out of the doula-client relationship.

3. Lobbying/Shmoozing

If I intend to get into the hospitals (where labour companions are currently unwelcome), I need to get the hospital staff to know me and understand what I do and why I do it.  I will begin by requesting meetings with the prenatal care providers (who only provide care outside of the hospitals, not during birthing times), and woo them, shamelessly.  It has been noted by other doulas and birth professionals that delivering goodies, treats, coffee, what-have-you along with business cards will usually secure a meeting with the doctors. In the USA (perhaps in Canada too…) pharmaceutical reps do this all the time to get their product into doctors offices.  I have in mind a few clinics that seem like they are open to a more wholistic approach to prenatal care and I will start there first.  Knowing with confidence that they will love and appreciate the community’s need for the services I have to offer, I will promise to cross promote their clinic.  Once I have infiltrated this level of care, I will learn more about the hospital system of obstetrics and continue to look for an opening there.  If none arises, I have another trick up my sleeve that involves selling a product to the hospitals for use in their labour and delivery wards.  Basically, anything that gets my face and personality and confident manner into their minds will give credibility to the the term DOULA.

4. Professional Development Opportunities

In addition to attracting more passionate birth advocates and feminists to the work–two of whom I plan to hire to work with me before the end of the year–once my name and face are known in the hospitals, I will begin marketing labour support education classes to the hospitals.  Continuing education for their nurses and L&D staff, based on techniques that are not known over here, and backed by statistics that show that this won’t add to their work load, it will actually make it lighter by having fewer instances that require medical intervention. I can’t offer too many details here just yet, but stay tuned…

5.  Build a Self-Sustaining Company

This is my end game. Before I leave Macau (because to be honest, my family has desires to be elsewhere in the long term), I want to have a company that can operate in my absence, continuing to share my ideals and philosophies with the next generation of birthing families.  But this is the long-term goal, one step, month, year at a time!  What this will look like in the short term will be branding, fortified by community service among the underserved community (in this case, it will be folks who cannot access my English-language services, and young/unmarried mothers in crisis pregnancies).  The community service will eventually be set up as a foundation in conjunction with the for-profit company so that one can feed the other, and the community can access it while keeping the birth workers working for comfortable living wages, and attracting more birth workers from the underserved communities to work with their own peers.

Connecting my long-term vision to the present, I absolutely recognize the need and right of all women birthing in Macau to have options and choices and feel that they are confident in making these choices work for them.  Starting work with the ones who are accessible to me (the English speaking, therefore most likely expat women) I will plant the seeds of change by allowing these first women to demonstrate what informed consent looks like.

Why Doulas’ Pay Should Never Be Discounted

In the Western world, where the doula profession is gaining more ground, it is common to hear of doulas practicing for free, or nearly so, for expectant parents who cannot (or in some cases will not) budget the cost of hiring them at their full fees. It is encouraged often in online forums “Find a doula who is seeking certification, she’ll do it for free!” And, “Every woman deserves a doula, which is why I offer a sliding scale for low-income parents.”  While it is certainly noble to volunteer one’s time, I do not believe free labour support is the answer to the problems our birth culture is facing.

The problem arises when doulas, who under most circumstances are self-employed, offers her services at a rate that is significantly discounted free, she is either able to afford the time and loss of income, thus making her independently wealthy, perhaps, and often known as a ‘hobby doula,’  a woman serving a community apart from her own. Or, she is giving her time and effort at the expense of her health, sanity, or her family’s income. This indeed is a noble act, but it cannot be sustained, and will lead to burnout, and an otherwise passionate and knowledgeable asset to the birth community being taken out of commission or losing her desire to continue this type of work.  Furthermore, it has been shown in many anecdotes that expectant parents do not take free or student or discount doula as seriously as they do a full price doula, leading to contract disputes, missed calls for labour, parents doubting or ignoring the doula’s suggestions to their own detriment, and many other instances that lead to disappointment and frustration on all sides.

Doulas worldwide have begun to realize that despite having a passion and loving what we do, we still deserve and must be paid for our work, no matter how sacred or direly needed we are.

In my own case, the birth culture of Macau is a challenging scene for a doula.  What I am counting on now is the demands of the expats to help change the culture. The English speakers are my target clients, as I do not yet speak Cantonese or Mandarin or even Portuguese (maybe next year!)  The way I see myself making the biggest difference is creating and spreading ideals of what labour and birth can be, so that more women   can begin to demand it from the hospitals.  Rather than lowering or waiving my fees to make my services accessible to everyone, I will encourage change in the system from the inside out.  Once women begin to feel more confident that their birth choices will be respected, they will stop fleeing the country to birth in Hong Kong or suffer in silence in Macau. Rather than saying “every woman deserves a doula” I’m thinking a little broader in my perspective with the idea that every birthing woman deserves options.  I owe it to the women of Macau–those who cannot afford my fees, or whom I cannot serve because of a language barrier–to stay the course and see things change.  I need to operate in such a way that will not only be sustainable to me, but to set the stage for any future doulas who choose to take up this work, but may not be able to take time away from their day jobs without sacrificing income.  The pay needs to be able to draw new doulas to the profession.  To quote the best comment I’ve seen so far on the subject:

If we keep insisting that the way to serve underserved populations is free and discount services, we close the door on people that are actually from that population being able to practice with their peers.  We make it so that the only doulas are middle class women looking to save the poor as a hobby.

September Phillips–notjustnine.com

So how do we serve the underserved? To put it simply, educate, rally the community and address the people in power.  In many communities this looks like a publicly funded or non-profit organization that provides working wages to doulas and free or nearly free services to qualified applicants. More on these topics in my next blog post.