Coming Events February 2016

I’m excited to announce my first month’s roster of events for pregnant and new parents here in Macau!

Being a parent can be difficult and isolating at times, and bringing up a family in a foreign culture brings its own set of challenges. What helps us grow beyond these challenges is engaging in community support. Conscious Wellness’ big mission in 2016 is to build that community to connect parent to parent, across cultural boundaries, so we can support each other through our mutual experiences in our parenting journeys.

With that in mind, here are the details: The breastfeeding group will run on the last Wednesday of the month, at 10:30am in the Starbucks in Taipa Village.  I’m open to suggestions of other cozy spaces around Macau to meet, but I know Starbucks has a corporate commitment to supporting breastfeeding families, so I figured that was a good place to start.

The HypnoBirthing® workshop is a little taster session I will be running periodically to encourage pregnant families to sign up for the full 5 week comprehensive childbirth education course.  The $80 fee is to cover my room rental costs as well as secure commitment, and can be used as a deposit towards the course fee if you choose to register.

One of my goals for 2016 is to give monthly talks on a variety of subjects relating to pregnancy and parenting.  The babywearing talk is the first in that series.  In the future I will be covering topics like safe sleep, cross-cultural perspectives on parenting, birthing options in Macau and Hong Kong, and postpartum mental health and wellness.

If you are keen to join me for any or all of these events, please let me know at my facebook page or macaubirthdoula@gmail.com.  Looking forward to seeing you all soon!

6 months of Cognitive Behavioral Therapy for PPD distilled into one blog post

I took this photo the day I completed my six months of CBT and group therapy for postpartum depression and anxiety.  It was a satisfying moment; feeling accomplished at something for the first time in a long while.  It certainly wasn’t the end of the road for me and perinatal mood disorders, but I was happy at least I had acquired a set of useful tools to deal with the day-to-day drudgery and ongoing balancing act of managing a mood disorder while being a parent (and an adult in general).

 

A friend of mine is currently having a hard time, as so many mothers do in North America, and I was reminded of the lessons I learned and prompted to put them in writing for easy access–for myself as well as others.  So here it is:

 

Six months of CBT distilled

 

1. Ask for and accept help, even if it’s embarrassing.

It may seem tempting to tell yourself, “I can get so-and-so to come over and help as soon as I’ve gotten around to tidying up a bit,” or some other ‘If –> Then’ scenario.  Don’t wait any longer.  Ask for help, and if someone is kind enough to offer, accept it.  Don’t try to minimize your needs to avoid inconveniencing others.  If you need help, you need it!

2. Get outside and get some sun on your skin.

Sunlight is beneficial to your mental health in a variety of ways.  It helps to regulate your circadian rhythms, which may be disturbed if you are having trouble sleeping, or sleeping too much.  It can wake you up and give you a little boost to just get one thing done today.  It also helps your body synthesize vitamin D, which especially in the winter you may be deficient in.  Some symptoms of Vitamin D deficiency are extreme fatigue, joint pain and depression.  Sound familiar?  Even 20 minutes outside in a winter coat is better than staying on your butt inside.  Make it a goal to do it at minimum every other day.

3. Get some exercise, even if it seems insignificant.

Pushing a stroller around a mall for an hour, even if you have no money and don’t even care enough to bother window shopping will get a few endorphins flowing through your body and give you a bit of a mood boost.  The summer of 2014 when I was undergoing the CBT and group therapy, I was flat broke more often than not, but one of the best things I did for myself was take my kids to the farmers market every Saturday.  I had a kind friend who had sent me a gift card for a local veggie vendor, so I always had an excuse to get out there, even if I didn’t have enough money to even afford a coffee besides.  Sometimes it was sunny, sometimes not, but it always got me out pushing the stroller around and getting a bit of exercise.  Make small achievable exercise goals.  If once a week is all you can muster, celebrate that.  If you think you can work your way up to 3-4 times a week or more, maybe consider making a walk to a destination like Tim Hortons for a cheap but enjoyable treat.  Don’t set your goals too high too fast, as it will only add to the mom-guilt when you can’t achieve them.  Save BeachBody for a time when you’re feeling more well.

4. Eat at least two decent meals a day.

Sounds easier said than done, right? It doesn’t have to be so.  Decent doesn’t mean fancy, it can be a sandwich with sliced carrots and celery or maybe an apple on the side.  Just make sure you eat regularly, and not just fistfuls of cereal out of the box or leftover Easter chocolate. Particularly if you’re breastfeeding, you need to sustain yourself with nutrients.  Your baby will always get what he/she needs from your milk, but if you’re not replenishing it in your diet, it will be at your body’s detriment.  Do yourself a favour and stock up on easy to grab raw snacks like crunchy veggies, fruit and nuts.  Be conscious of going overboard on the carbs, as it’s always a temptation for folks when they’re beyond burnt out, but they only provide temporary relief from symptoms and often make you crash harder when your blood sugar drops after a while.  And don’t forget to drink lots of water!  Set a reminder on your phone or keep a tally on a whiteboard in your kitchen.

5. Get out and see a friend

It’s easy to push socialization to the back burner when you are behind in so many things, feel like garbage and can’t be bothered to brush your hair.  But getting out and being seen and heard by someone who knows you and appreciates you for being you, and not just a diaper-changing milk-machine, can be very therapeutic.  Humans need socialization for their emotional well being, so don’t put it so far down the list that you end up going weeks or months without any meaningful adult interaction.  Consider it a must for your mental health, and make a date, even if it’s just running errands together.

6. Be kind and forgiving of yourself.

Perinatal mood disorders (in case you haven’t heard, depression isn’t the only problem that affects new moms, anxiety, OCD and PTSD happen too) are a BITCH.  They rob you of an accurate view of yourself and tell you you’re a failure or a bad mom. It’s not true. You have an illness and it needs to be treated, same as if you had pneumonia or hepatitis. It is not something to feel guilty about or that you should just get over.  So don’t sweat when you have days where the best you can do is get out of bed and change into cleaner pyjamas.  If you find that it’s too much of a struggle to get the basic necessities for your child (food, safety, clean diapers), or are having suicidal thoughts, go to the doctor immediately.  Make sure your spouse (or closest relative or friend if there is no spouse) knows exactly how badly you feel.  It may seem like it’s totally obvious to you, but your spouse may not realize the extent to which the mood disorder is affecting you.  That said, take it one day, one hour, one moment at a time. Breathe. Let it go. Start again.  This shit is HARD, and it’s ok to be gentle with yourself about it.

7. Get enough good-quality sleep.

Yeah. That may seem like a pipe-dream for some new families.  But if you’re getting your circadian rhythms set properly with some sunlight, and you’re getting a bit of exercise, it may be easier to get good quality sleep when sleep time is available.  Sleep with your infant in your room so you don’t have to go far for night feedings.  Take a nap during the day.  If you have an older child that won’t nap, make an arrangement with a friend or neighbour to take him for an hour or two a few times a week so you can catch up on zzz’s.  Regular, (mostly) uninterrupted sleep is crucial to your brain and mental health.  Make it a priority and enlist the help of your co-parent to get it figured out for yourself.

Moving Forward

Once you’ve done two or three things on the above list, make a list of the things you need to get done to get your responsibilities and life back on track. Laundry? Dishes? Vacuuming, picking up? Delegate those tasks to friends who ask how they can help, or if no one’s offering, ask them.  Ask older siblings and spouses to pick up an extra task.  If they’re not available or it’s going to be more work than it’s worth to convince them, ask from your local friends and family.  If none of those exist, consider hiring a maid or a postpartum doula. If the money’s not there, consider asking well-meaning but geographically distanced relatives and friends for help to hire a professional.  Find a way to surround yourself with support.

Please let me know if you’re having trouble with any of this, or comment if you want to share more tips for weathering perinatal mood disorders.

With love and admiration,

Macau Birth Doula

 

 

Chatelaine’s Women of the Year 2015

I loved reading about inspirational Canadian women in this article. There are a few I was definitely really impressed with this year, namely Mrs. Universe Ashley Callingbull and Green Party of Canada leader Elizabeth May. But my favourite quote from this listicle was about 94 year old landscape architect Cornelia Hahn Oberlander, about her success: “What’s her secret? The “5 Ps” that have guided her six-decade plus career: patience, persistence, politeness, passion and professionalism.”

Sounds like a brilliant concept to bring into 2016.

 

Who are some women who inspired you this year?  What lessons have you learned from them that you will be carrying into 2016?

Breastfeeding in Macau: Current Status and Advice from an Expert

Recently I had the good fortune of being invited to attend an all-day seminar about breastfeeding, presented to the medical community of Macau.  Dr. Jack Newman, a world-renowned expert on breastfeeding presented four lectures throughout the day, which I will comment on in later posts.

The general theme of his advice to the Macau medical community was that, in order to improve breastfeeding outcomes here, a few things need to change from a government and hospital policy standpoint.  The WHO recommends children be breastfed to the exclusion of all other foods until approximately 6 months of age, and continue to breastfeed in conjunction with solid foods until at least 2 years of age.  I don’t have the current stats for Macau on hand, and I will research them and get back on this, but it is safe to say that from the social reaction of most mothers to this idea, it is not common that Macau babies are getting the full benefit of their mother’s milk.

Among Dr. Newman’s recommendations: extend maternity leave from employment.  Compared with Canada (52 weeks) and some European countries (3 years), Macau has mandated 8 weeks maternity leave.  This does not leave enough time for mothers to exclusively breastfeed their children until they are old enough to eat some solid foods while their mothers are away working.

In addition to the maternity leave, mothers and newborns will be able to eliminate certain breastfeeding challenges at the outset if they are able to room-in together at the hospital after birth.  Keeping newborns in separate rooms from their mothers disrupts bonding, and affects a baby’s ability to better handle early challenges of hypoglycemia and jaundice.  Babies and mothers belong together from minute one,  for a wide variety of reasons, not insignificantly because it helps them to establish their breastfeeding relationships. They learn how to communicate easily and effectively about feeding, and can feed on demand, rather than on a schedule or depend on another person to notify them when their baby is crying.

For more of his comments (and a brief soundbite from yours truly!) watch the segment on TDM English language news starting at 8:20 here.

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.

December 6

Today marks three years since my 20 week ultrasound with my daughter; the day it was confirmed for me that she was to be born a girl. It also happens to be the anniversary of the massacre at the ‪#‎ÉcolePolytechnique‬, a day that is marked in remembrance every year in Canada, as the National Day of Remembrance and Action on Violence Against Women.

It is also a lesser-known anniversary: the day that marked the beginning of my most recent struggle with anxiety and depression. Perinatal mood disorders may be triggered by many different things during a woman’s childbearing year; for me it was the thought of bringing a female child into a world that more or less realistically is dangerous for females. Although I fought through panic attacks telling myself they were isolated episodes and could be explained away, I did not seek treatment for my disorder for almost a year later. It did not even really occur to me that ‪#‎PPD‬ might actually also mean PRE-partum (terrible grammar, but you know) depression or anxiety.

So here’s to raising the awareness. Perinatal mood disorders happen. They can be treated. There’s no reason to delay treatment or try to just work it out alone. Help is available.

 

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.

Attachment Parenting, Depression and Cognitive Dissonance

**TRIGGER WARNING: Perinatal depression, anxiety, mom-guilt**

 

Infant sleep hygiene is such a touchy subject because of the cognitive dissonance it incites. As a self-professed gentle parent, I feel like I should always walk the talk, but in all honesty, as a person who experienced severe perinatal mood disorders, there were times I had to prioritize my values, and yes, this led to some cry-it-out. I believed what my maternal instincts were telling me, but I had to do what I did to keep myself and my family safe. I’m sure most mothers are not quite as perfect as they’d like to be, so I’m just trying to make the point that knowledge is power. Know better, and do better when you can. Sometimes the best you can do is make a compromise until you find a better solution, with infant sleep and other parenting choices, knowing is half the battle, figuring out how to make it work for you and your family is the rest of it.

When you have to walk away

Sometimes your baby will cry. Sometimes it is something you might be able to figure out if you were in a normal state of mind, but in the all-consuming fog that is depression, the simple answer just isn’t coming to you. If you find you’re at the end of your rope and you and your babe are just ratcheting up each other’s anxiety, step away for a few minutes. Do some deep breathing, singing, jumping jacks, whatever it is you need to do to remind yourself this is not your fault. And more importantly, this is not the baby’s fault. It sounds terrible, but I am sure I am not the only one who has had the fleeting thought that the baby is trying to punish me for being a bad mother.  For the longest time, when my baby got upset I could hear in her cries the accusation “you’re not good enough!”  With cognitive behavioral therapy I learned coping skills that helped me to immediately recognize these “hot thoughts” and replace them with more rational ones.  In the interim, the best choice for me was to take a moment and collect myself before my raging emotions ran away with me and I did something destructive.

When the Attachment Parent becomes detached

It’s long been a coping mechanism for me to detach from my emotions when my anxiety got to be too much.  Having a newborn/infant/toddler does not allow for a whole lot of detachment. By their very nature they require conscious connection to learn their value and worth and how to regulate strong emotions and so much more.  For a long time, I was not able to provide this. After my daughter was born, in the throes of PTSD, including frequent panic attacks, flashbacks, insomnia, etc, I became an expert at playing Candy Crush on my phone. It was a crutch, admittedly, but a crutch I direly needed to keep myself and my children safe.  Again, through therapy and education I learned the value of taking a time out, even just for 5 minutes to regulate my emotions.  Better regulated, I could return to my children and be my whole, imperfect self and seek their forgiveness. Children are incredibly flexible, if you give them the benefit of allowing them to see you in your honest and open state. Sometimes coming to them and just saying “mommy’s hurting right now, I need your love and patience” made a world of a difference. My 3 year old in particular is exceptionally sensitive and empathetic, and allowing him in (once I’ve had the chance to calm myself to a state where I’m conscious and aware of my emotions) rather than pushing him away when I’m at the end of my rope helps to heal both of us.

Facing and healing the Mom-Guilt

We put a tremendous amount of pressure on ourselves as mothers to be the best we can possibly be. What that looks like varies from person to person, but suffice it to say, we all do our best for our children. Except when we don’t. Sometimes we have bad days, and with postnatal depression the bad days seem to come more often than not.  So how do we forgive ourselves for doing less than what we know to be our best?

Self-care is key. We can’t expect ourselves to perform at the top of our mom-game if we aren’t caring for ourselves first. When we are well, we do well. When we are less than our best, we still do the best we can in the moment. The first and most important self-care I do is letting go of yesterday and focussing on what I can do for my family today.  Recognize if it is less than what they truly need, and then ask for help.  If there are a few days in a row where I’m lagging, I ask my husband for help in pointing this out in a compassionate way so I can examine my recent self-care habits to see if there is anything I can change. Sometimes it’s as simple as going to bed an hour or two earlier for a couple nights so I can catch up on some sleep.

Self-Care activities to try

Go to bed an hour earlier. Get out once per week without the kid(s) for an hour or two to get a latte and a manicure, or a massage, or just read a book at the park.  Wear ear plugs and a sleep mask to bed. Download some self-hypnosis scripts for aiding in relaxation and improving outlook and optimism.  Chat with a friend.  Turn on some happy music and have a dance party with the kids. Get in the bath with the kids and let them pour water on your head and giggle. Go for a walk in the park, get surrounded by trees or feel the ocean breeze.  Take a yoga class or put on an exercise DVD.  Drink lots of water.  Journal your feelings. Find friends with whom you can share all your fears, emotions and insecurities.  Develop a ritual to Let. Them. Go.  Practice breathing exercises. Meditate. Give yourself the opportunity to be vulnerable, it will heal you more than you can realize.

I promise once you have set aside the time a few days a week to practice some self-care, parenting the way you want will come easier.

If you feel that you are suffering from a perinatal mood disorder (depression, anxiety, PTSD, OCD) please reach out to your health care practitioner for help and guidance to set up a treatment program that will work for you.

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.

Birthing culture in Macau

I’m a doula who recently moved to Macau. For those who don’t know, it’s a former Portuguese colony that is now a region of China, although it retains some autonomy in its government.

The birth culture here is such that:

• As far as I know, I’m literally the only doula in town;
• Women birth on in communal wards managed by strict nurses who tell them to keep their screams quiet;
• Birth partners are not welcome in the wards, there are no waiting areas in the hospital, so they are told to go home and wait for a call to let them know their child has been born;
• The only other choice for prospective parents to take in managing their own births is to travel to Hong Kong to birth at a private hospital, which means a one hour ferry ride plus transit to the hospital from the ferry terminal.

Women that I have spoken to about their birth experiences have been traumatized–particularly first time mothers who don’t speak Chinese and cannot have procedures and protocols explained to them before they are subjected to them, i.e. the basis of informed consent.  No tours are given of the Labour and Delivery suites, no childbirth classes offered in any language other than Chinese. Despite the trauma that some experience, many women accept this standard as the status quo, and are resigned to have any subsequent children the same way saying “at least I know now what to expect.” It has been intimidating, to say the least, as a doula coming into this scene. I am not currently welcome to practice my work on the labour wards in this country. But rather than tuck my tail and run to get a job at Starbucks, I am inspired to endeavor to change the birthing culture here to one that is more family-centred and woman-supported.

Nonetheless, I have been welcomed with open arms by several expats and an occasional local and am greatly looking forward to sharing my knowledge and passion about gentle family-centred childbirth, informed consent and women’s rights.  The more I do it, the more I love my job, and I am very excited to meet the challenges that await me head on. Stay tuned for updates on my impressions of the birth culture here in Macau!