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.

Feb 2016 events

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!

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

We-Can-Do-It-Rosie-the-Riveter-Wallpaper-2So 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 GaskinIna 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!

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.