How NOT to tear...

Just make a sign like this (the red crepe paper heart will take a long time to make!) and put it up above the head of the bed in the birthing room...and everyone will make darn sure that you don't tear!!!

Then, the nurses will put it up in their staff room to make sure that they never forget and pass it on to all the other wonderful women who pass through their doors...

Thanks to Lisa for her strength, determination, and love of glue-stick and crepe paper! (more on her amazing birth later...)

- Jacquie Munro, Vancouver Doula, Slow Birth, Slow Planet

My dysfunctional love of statistics

I loved statistics so much in university. Honestly! I'm still such a geek, that I love to look at my client's stats...not at regular times of the year (like December 31st), mind you. I like to do it when the spirit moves me (the happy convergence of left and right brain.) Or might it be tax-procrastination time?

So, here's this past 12 month's basic statistics...

Of 62 clients, 43 (69%) had spontaneous vaginal births without any major pain medications (epidural or narcotics), 10 (16%) had spontaneous vaginal births WITH an epidural, 2 (3%) clients had assisted births (1 vacuum, 1 forceps), and 7 (11%) clients had cesareans (2 breech, 1 face presentation, 3 dystocia, 1 fetal distress). Take some time to think about that. Only 5 clients (8%) had unplanned cesareans. What's the average in BC?

The majority of hospital births were at BC Women's (46, 74%), followed by St. Pauls (9, 14.5%), Lion's Gate (2, 3%) and Royal Columbian (1, 2%). Five clients planned for a home birth. Of those, 4 were successful (one had to transfer to hospital for meconium at 10cm, but happily birthed then went back home). There was also 1 unplanned home birth (luckily, she had fast-moving midwives!) So, only 6.5% of births were at home. Okay...I need more home births!

As for who was caring for my clients, family doctors top the list with 37 (61%), followed by midwives at 16 (25%), and OBs (9, 14%). The BC Women's FPMS birth docs cared for a whopping 37% of my clients. Thanks to all who did such a great job of making slow births happen!

A lot of people think my clients stats must be so good because they are having second or third babies. Well, almost three-quarters (46, 74%) of my clients were having their first baby. Only 16 (26%) clients were having their second or third baby, and 12 (19%) of those were returning clients. Of the four new clients who were "multips," one had a home VBAC, one had a home water birth, another had a home birth after a traumatic first birth experience in another country, and one was over age 50!

You might also say that my clients have great births because they must all be very young and highly motivated. But, most are over age 35, many are over age 40, and most would have been fine with an epidural or cesarean if it was medically necessary.

But, after many months of working together, these women were all motivated to have a slow birth...to listen to and trust their bodies...to allow for the natural rhythm of birth. And, with good support, and a great team (who can sometimes collaborate silently, with only eyes and hands to communicate)...it just worked!

- Jacquie Munro, Vancouver Doula, Slow Birth, Slow Planet

In which a push mower acts as sweet music...

On Saturday afternoon, I was dropped off at a client's Co-op on the Downtown East Side. As I walked to their door, a nurse from the local InSite walked by and smiled at me, a man with a grocery cart full of his belongings rattled down the lane, and a siren began to wail.

Once I was inside the door, though, another series of sounds took over...the cry of a woman in labour with her first baby, the shouting and shrieking of children as they played in the Co-op playground out back, the unexpected rhythmic whirr of a push mower acting as sweet green music. I had entered a hidden oasis only a block from Hastings and Main. It was cool, calm and wonderful.

She laughed and asked if I could hear her from outside...

We added the sound of the fan to the mix, and helped her to move, rock, sway, stomp, go on tip-toes, shower. She became calm when I talked her through contractions. She was kind and gracious in labour, only snapping once as her husband came into the bedroom to ask if I'd like some lunch, while holding said food in his hand... "Out!" Yes, labour increases a woman's sense of smell!

With the sounds of children and the lawnmower and the woman and the fan blending together, all sense of time disappeared. We were outside of time. As the contractions became stronger, she became more and more calm, toning low and soft. She melted open.

One last time into the shower with the fan blowing steam out of the bathroom and cooling the air. Water spilled onto the floor. We heard her growling. We smiled. Her husband put his head down for one last moment of quiet.

Then we headed through the streets in my car, as she dozed in the back seat, head leaning on a homemade quilt which covered the birth ball. One contraction, two contractions. That's all she had in twenty minutes. She was in that quiet slow space before pushing...

Then, a hint of a sound like she wanted to push as we arrived at the hospital. 9+ centimetres!

And she rode upstairs and pushed and pushed and moved and worked, and never gave up, and then...more than 3 hours later...beautiful pink Josephine (named after her grandfather) arrived, head askew, looking up at her mum...born completely posterior!!! She called out in her sweet voice and cried to let everyone know that she had arrived.

What a day of sweet music!

- Jacquie Munro, Vancouver Doula, Slow Birth, Slow Planet

Slow Birth call to action

My goodness!

Dr. Lauren A. Plante, a US obstetrician, has written a wonderful article (a MUST read!) in response to the increasing industrialization of childbirth (wasn't Canada's own Dr. Andrew Kotaska one of the first to argue against "industrial birth"?) Dr. Plante asserts that on-demand cesareans do not represent the height of women's autonomy, but are, in fact, the opposite. She calls for true autonomy for women - the right to choose from a spectrum of choices.

At the end of the article, she links the Slow Movement to childbirth, and almost challenges women to start a grassroots birth revolution. This is the first academic article that I've found that mentions Slow Childbirth. Wahoo!

The Slow Birth movement is organically growing! Read the excerpt below, then click the link for the full article...think about how you can be part of the transformation...

Come on - bring forth the change!

- Jacquie Munro, Vancouver Doula, Slow Birth, Slow Planet


Plante, L.A. Mommy, What Did You Do in the Industrial Revolution? Meditations on the Rising Cesarean Rate. The International Journal of Feminist Approaches to Bioethics. Spring 2009;2(1):140-147.

Excerpt:
"As a reaction to industrial agriculture and food marketing, the Slow Food and locavore movements have recently been born. If de-escalation of our food production practices is healthier or more humane, why is intensification of our child production practices better than sustainable childbirth? I’m waiting for the birth of the revolution, or at least, the revolution of birth. Will women who are interested in Slow Food or cage-free eggs find their way to a Slow Childbirth movement? Imagine: educated upper-middle-class women who buy songbird-certified organic coffee and worry about their carbon footprint, just saying no to the quick-fix cesarean culture. If they’re not part of the problem, maybe they can be part of the solution. But the impetus must come from women themselves. Do we really believe that industrial obstetrics is the best model for ourselves and our children? We must clearly understand that real autonomy does not mean cesarean on request, but instead a spectrum of birth options that honor women’s authentic choices. Real autonomy also means, to borrow a sentiment from Gandhi, that women should bring forth the change they wish to see in the world."

The Green Generation

It's Earth Day today! And it's Isola's and Milo's birthdays, too! They are just two of my client's babies who are part of the "Green Generation." My hope is that they will grow up with the smallest carbon footprints possible. I think they're pretty special one year olds, so they might be able to do it and be worthy of the title.

Now is the time.

So, am I, as a doula, "green?" I try to work with clients who live within a small area. I can walk home from both birthing hospitals. In labour, I help clients in their own homes, usually arriving on foot or on a bike. I help clients stay out of the hospital system for as long as possible, while remaining connected to their caregivers by phone. My clients rarely need IVs, epidurals, drugs, or any major assistance. My clients often go home as soon as possible (or birth at home with midwives). The majority of my clients are able to breastfeed successfully, and don't need to buy bottles or formula. Most of my clients use cloth diapers (well...at least during the daytime!) They also need less future counseling as a result of their positive experiences.

Think of the cost savings, the environmental savings! That's what I call a "green birth!"

We might wash some of those savings down the drain with the amount of hot water that my clients use in labour...(but SHHH don't tell anyone!)

That's probably a small price to pay for the long-term joy that an amazing birth brings to a family.

And I discovered today that there's a residual "green" impact. Today, Isola's mum called me up on her daughter's birthday, and we both started to cry as she thanked me for all the help that I gave her during her pregnancy and birth. Think of the long-term ramifications of a "green birth" on her and her daughter, and her family!

This mother will always tell her daughter stories of her joyful undisturbed birth, and this little girl will probably have a "green birth" in her future. She's truly part of the "Green Generation."

So, Happy Earth Day! Wear some green!

- Jacquie Munro, Vancouver Doula, Slow Birth, Slow Planet

Bike the Blossoms

"Abandon your fast life for another day of s l o w ..."

Whether you're pregnant or not (hey, I rode my bike until I was 8 months pregnant!) come and join other Slow Vancouverites at the Bike the Blossoms 23k ride sponsored by Slow Food Vancouver this Saturday, April 18th. It's only $10 each, and you'll be supporting the s l o w movement.

This self-guided tour is fun for the whole family! Enjoy a leisurely ride along boulevards of spring cherry blossoms, traveling through a diversity of neighbourhoods from the eastside to the westside, stopping at local community centres to meet local farmers, to sample local foods and refuel at slow food designated eateries, restaurants and cafes along the way.

Slow Birth will be there! Come join us!

(Apr. 19 - Well, that was fun! I saw lots of families with babies in various carriers riding through the city streets, but didn't spy any noticeably pregnant riders. And the weather stayed sunny and warm! The next day, at the Sun Run, I saw a LOT of pregnant participants - yahoo!)

- Jacquie Munro, Vancouver Doula, Slow Birth, Slow Planet

Slow Stories

I started to take notes during each birth after November 1, 1993. I know that because Kieran was born on that day. Kieran was a warrior baby. In fact, he was born face first. He never gave up with that chin-up attitude (and probably still hasn't to this day!)

The midwife did one final vaginal exam just before he was born. "Is that a bum?" she asked, just a little confused for a moment. "No, it couldn't be...you're hearing the heartbeat in the right place. It must be a mouth," I said. "It's the baby's lips!" she called out. So, Kieran was born, after a crazy challenging labour, with his mum on her high bed, holding up her silk dress (dad had grabbed a dress for her to wear, and I think it was one that she'd recently worn to a wedding).

Days later, when we tried to have "tea and debrief", Keiran's mum, my doula partner and friend, cried, as she tried to piece together our collective memories of what happened at the birth. Her first labour had been so smooth that we had expected a quick second labour. This days-long hard labour had been so relentless, with intense back pain, that we had all lost track of time.

She told me that she had keenly felt the loss when I had left her head and gone to help the midwife during those critical moments when we didn't know whether the baby was head down or breech. A woman needs another woman at her ear, whispering, "You are safe." I wasn't there for her as a doula in the end. I had become the second attendant.

We had no birth notes from those days of long hard labour - no framework from which to hang the memory. She was lost.

She asked me if I could write notes for all the women who would come in the future, so that no woman would ever have to wonder "What happened?"

So, now, I write as honest and true a story as I can write. I can only write what I observe, being on the outside of each woman's experience. I try to make sure that my handwriting is slow and calm. I watch my writing become larger and messier as the baby's birth moment approaches. Water drops on the page. A drop of blood smears. This is the external story of a birth.

I ask that each woman and her partner take some time to record their own experience, before I give them my birth notes as a gift. Each written account is part of the memory of the birth day. But, it's the woman's internal story which is paramount. Who cares that my notes say that she was in the bath for 5 hours. She believes that she laboured in the water through the night. She believes she was surrounded by candles (when candles are not allowed in the hospital) and peacock fans (when it was really a cardboard tray). She believes that she was rowing for a gold medal, not panting for hours. Her reality is the truth of the birth.

But my notes do provide something that she may never remember - her first words as her baby emerges. And now, most women don't cry because of a lost story, they cry with joy, when they read the words that they said to their newborn:

"I'm so glad to meet you!"

"That might have been the best thing I've done in my life!"

"You are so beautiful!"

"She sounds like a sheep!"

"Holy cow! It's a baby! Look! It's a baby!"

"You're sure a lot louder than I thought you'd be!"

Kieran's mum is moving back to the west coast very soon, so we'll have another "tea and debrief" very soon. And she'll probably tell me that my memory is faulty after all these years, that she actually wore her silk dress when her baby Zoe was born. And I'll tell her that, at the very least, my memory is clear about her strength in labour. The sound memories are clear, too. The garbage truck, the children outside. And I'll say I'm sorry that I left her head during Kieran's birth, and that I think of her every time I whisper, "You are safe," to each woman as she gives birth...

And then, we'll tell more slow stories of our lives...

- Jacquie Munro, Vancouver Doula, Slow Birth, Slow Planet

Life Cycle

Something as simple as a bike can save lives!

It only costs about $70 to purchase an International Planned Parenthood Federation Good Gift Bicycle for a midwife in a developing country.

If a midwife in a developing country owns a bike, she's able to visit more villages. Unfortunately, too many midwives lack cycle mobility, so, considering the local current price of a bicycle and its life-improving qualities for far-flung villagers, you couldn't deliver a better gift.

For us, riding a bike to visits is truly a luxury. But to midwives and other health care workers around the world, it's a necessity. Please think about making a donation!

- Jacquie Munro, Vancouver Doula, Slow Birth, Slow Planet

Slow Bike "Rounds"

I fulfilled a childhood dream yesterday. As a child, I always wanted to be one of those women who rides her bike to visit mums and babies.

I must have heard about it from my mum and her friends, talking about their pregnancies in the north of England in the 1950's and early 1960's. The image of the local village midwife, riding to visits on her bike, just stuck with me. It seemed slow, perfect, just the way someone should visit you when you have a new baby.

That (and reducing our carbon footprint) was why we moved back into town. But, it's only since I've had my shiny new yellow road racer that I've felt brave enough to do my client visits by bike.

So, when I realized that my son had my car, and I had to do a few visits in Yaletown, I bit the bullet, and headed out over the windy bridge. There's nothing more satisfying than going to visits in the busy downtown core and not having to worry about traffic, red lights, or parking. I even managed a whirl on the False Creek bikeway. Between visits, I stopped at a little French bistro, sat in the sun at a cafe table, and ate my lunch while answering the inevitable (but fun!) phone calls from two postpartum mums.

Thanks to my clients who didn't mind seeing me dressed just a little less professionally...what? my blue dragonfly jersey isn't totally business-like? Thanks also to my clients who didn't laugh at my helmet-head.

I rode home from my lovely visits with a parting gift of chocolates dangling from my handlebars, 30km/h (over the speed limit!) on the last bit of the bridge, past the Planetarium, under the bridge, past the Granville Island tourists, and up the hill to my home. Fabulous! Then the phone rang again. I put the kettle on and chatted some more. A pretty amazing realization of a childhood dream.

So, be forewarned...I'll probably be coming to see you on my bike very soon - glowing, shiny and smiling!

- Jacquie Munro, Vancouver Doula, Slow Birth, Slow Planet

Warrior Birth

"Next time I'm just booking a cesarean."
"My first birth was so traumatic - I want drugs the moment I start labour."
"I can't walk through the door of a hospital again."
"I think we'd better adopt our second child."

To all the women who say these words...
Please know that it wasn't your fault.
It wasn't your faulty body.
It wasn't your faulty mind.
It wasn't that you lacked will power.
It just wasn't a normal labour.
No guilt or blame.
It just wasn't a normal labour.

If you were surrounded by loving, caring people.
If you did the best you could, but the birth still shook you to your core.
If it was long and hard and unfathomable and didn't feel right...
there is usually a simple explanation.
Something just wasn't quite right.
It didn't have to be something big.
It could have been a sweet pair of hands by the baby's face,
or a head tilted to one side,
or facing out a hip,
or looking upwards.
Just bad luck on a big day.

This is the baby who didn't get the memo
about optimal positioning for birth.

Picture the baby who will come out simply and easily.
She's tucking her head down on her chest,
facing mum's bum,
has her hands in her pockets,
and is going to win the Olympic gold medal for the skeleton competition in 2030.
She's aerodynamic, flexible, adaptable,
and able to negotiate all turns with the grace of a pro.

She's lucky
born in the bathtub,
with her mum laughing.

Don't be hard on those babies who didn't get the memo,
those babies whose mums made those scary comments after the first birth.
These babies will never follow the crowd.
They'll be fiery and challenging, but totally brilliant (that's my girl!)
They're the ones who create great architecture, great music.
They are born with these passions tucked deep inside.
(Or maybe that's just me trying to put a positive spin on a difficult labour.)

The posterior/transverse/deflexed/asynclitic/compound presentation baby
tries to negotiate the birth canal
like a pine tree on the edge of a wind-swept cliff edge.
Bent, twisted.
He faces the hip, or faces forward, chin up, whatever the consequence.
This is not a birth for the faint of heart.
This is a warrior's birth.

So, when a woman calls to tell me about her first birth,
that long, epic first birth,
the one that she never thought would end,
and says that she can't ever do it again...

I ask her to thank her first baby for all the work that he or she has done.
We must not worry him or blame her.
First births are unrelenting in their demands,
because that is what is needed for us to be the best mothers to our children.
I remind her of her strength, her courage, her power as a mother.

She must have been a warrior to make it through
and out the other side.
She needs to know that it can be different,
oh, so different the next time.
I, too, have made it through that kind of a birth
then danced in the shower with my second.

She is not alone.

And, like Katie, she may choose to have her next baby at home, with the fan on, in the summer.

And, like Jasmine, she may not actually believe she's in labour until it's almost too late for a car ride, and then pant and blow through the tunnel to the hospital, and have the baby quickly on the other side.

And, like Lisa, she may find herself doing the "buzzard lope" around the house, and only get on a bed for the last few minutes of a beautiful labour.

And, like Trish, she may choose to have a vaginal birth after cesarean on her living room floor, while the trees blow outside.

And, like Shelley, she may not believe that her second birth could actually be easy until the last minute, and give birth standing up in the hospital bath-tub, then order baby back ribs for dinner.

She is not alone.
She can do this,
no matter what happens

This is her story.

- Jacquie Munro, Vancouver Doula, Slow Birth, Slow Planet

Food, glorious food!

Women often ask me if they can eat once they're in labour.

"The books say I shouldn't, but I'm such a hummingbird eater, that I'll keel over if I don't keep eating!"

"Oh, please listen to your body, and it will let you know what you should eat, and when you should eat," I answer.

Think of the fuel that your body needs to do this amazing work! It needs fuel and fluids to function properly. Can you imagine doing a marathon, triathlon, or long-distance bike race without any nourishment? You'd be the one saying, "I bonked so early, it was embarrassing!"

But hospitals are slow to change their policies. Some local hospitals provide lunch trays to women in labour, but others discourage food intake, "in case she needs general anesthetic." A client's husband (an anesthesiologist) recently reminded everyone that he provides general anesthesia to accident victims who've probably just eaten their dinner, and everything is fine. And, he asked, just how many times do labouring women require general anesthetic in labour? Probably not enough to make it necessary to starve all the other women.

I remember being at a midwifery conference 19 long years ago. A young British midwife had dared to study food intake in labour. She found that there were far more complications among women who didn't eat in labour. She also found that most women naturally throw up at around 5-6cm., and that it's better to throw up something than nothing - way less acidic! All the midwives stood and gave her a round of applause, and declared that this would put an end to giving women only ice chips in labour.

But, 19 years later, that paper, and all the subsequent research, hasn't totally filtered down to the community level. And, "don't eat in labour" is still in so many of the childbirth books!

The hundreds of stories that I could tell about eating in labour...

But, here's just four memorable ones...

The British woman who made me sit there while she finished making a full roast beef and yorkshire pudding dinner. When it was ready, she sat down, took a mouthful, took a break to huff and puff, then ate another mouthful, took a break to pant... She kept going until her plate was empty. Then, and only then, were we allowed to take her to the hospital.

The woman who lived on the top floor of an old house behind the Park Theatre. She grabbed a tupperware container full of scones, to eat in the car on the way to the hospital. The container was empty by the time we arrived at the hospital. Her water broke as she walked through the doorway. She was deaf, so she would laughingly ignore anyone who tried to tell her what she could or could not eat.

The woman in Yaletown who asked her husband to cook her "an omelette." Well, he made a 3 egg omelette thick with peppers, mushrooms, onions, and sausages. Unbelievable! She walloped it off! (Sorry, to translate - "walloped it off" means "ate it really fast!")

The Burnaby woman with a black belt in Tae Kwon Do who had her husband run to the market to buy her papayas. She ate two. (Little did she know that her natural urge had led her to eat a fruit which can increase the power of uterine contractions.)

These women all arrived at the hospital late in labour, and had their babies in short order.

Food, glorious food!

- Jacquie Munro, Vancouver Doula, Slow Birth, Slow Planet

An adagio hits a day of speed at full force

I've noticed that I can manage most things as long as I move slowly through the day.

Within a few weeks, my children and parents will all be living within an easy bike ride.

I can walk or ride my bike to visit most of my clients. (Yes, you can expect helmet head when the weather is good!)

I can walk home from both BC Women's and St Paul's after births (there's nothing like breathing in the crisp early morning air as I walk over the Burrard Street bridge at 6am.)

The huge physical and emotional effort required to be intensely focused on a labouring woman and her family for hours and hours (sometimes days) is only possible when I live slowly, with intention, and gain strength by moving through the world using only the power of my legs.

Last week, I was reminded of how I used to live with the continual drain of moving at high speed. (How did I spend 17 years doing the 60km daily return commute from Tsawwassen?) So, there I was, driving along the highway to visit my best friend in Crescent Beach (I can only manage this 90km drive about once a month, now that we live a Slow Life). My iPhone alerted me to three email messages, two clients called to talk about miscarriage (on speaker), another called to let me know that she was in early labour, my mum called to say that my dad's blood test showed that his leukemia was gaining an upper hand and a blood transfusion would be needed soon, and a postpartum mum called to talk about her baby's latch.

And behind all of that, like a sound of a cellist playing Albinoni's Adagio in the background - pulsing, throbbing - was the vision of a client's beautiful 8-month-old daughter who had just lost her battle with an unknown lung disease. She is the first child ever lost to a client in 21 years.

The sad music of her mother's face.

I could have handled it all, if I'd been riding my bike, drawing on the strength of my body, the pumping of my heart, feeling connected with the world. But, somehow, it just all seemed too much, driving at 110km/h. 120 km/h. The adagio had hit this day of speed at full force.

I needed to be slow. I needed physical and emotional nourishment. I needed to be home. I needed to sleep long and deep. I needed to help a new mum and her baby that afternoon. I needed to visit a joyful pregnant woman. I needed to cry. I needed to hug. I needed to dig in the garden with my dad. I needed to help a baby come into the world. I needed to ride down a hill and breathe.

And, once I was back home, I was able to do all that, and more. I regained my footing, and I was able to be there, focused and strong, for everyone, and for myself. Slowly.

- Jacquie Munro, Vancouver Doula, Slow Birth, Slow Planet

"The light is round like a ring and we move within its movement."

Inside the light
your soul circles
winding down until it dies out,
growing like the ringing of a bell.

And between dying and being born again
there is so little room, nor is the frontier
so harsh.

The light is round like a ring
and we move within its movement.

from Not Everything is Now by Pablo Neruda


How do I write about the hidden realities of pregnancy? How do I write about the "opposite of birth"? How do I write about that unknown space between life and death?

In this blog I focus on the joy of working with pregnant women, attending their amazing Slow Births, and helping them through their postpartum journeys. But there are other journeys that some must travel. I hear their stories. Now, it's time to start telling some of these stories.

Because so many clients stay in touch with me after their first birth, I'm often one of the first people to hear about the second pregnancy: "I'm signing you up right away this time!" I've even had some phone calls from the bathroom! "Guess what?!"

But, since it's estimated that up to 20% (or more?) of all pregnancies may actually result in miscarriage, I also receive a number of phone calls each month from those same women - as they experience early pregnancy loss. They call me from bathrooms, from cars, from bedrooms.

"I started spotting this afternoon. What does it mean?"
"I just felt such a strong sense of dread that I went to the ultrasound knowing that something was wrong."
"I thought I was 14 weeks, but it stopped growing at 8 weeks."
"They say it was an empty sac, an anembryonic pregnancy. They say it was never a baby."
"I wasn't feeling sick any more, and I just knew."
"I think I'm having a Slow Miscarriage."
"I took the misoprostol and NOTHING HAPPENED. Can't believe it."
"Tennis ball sized things (blood clots) were coming out. I collapsed."
"I'm really struggling."
"It all happened the way it was supposed to. It was sad and awful. But it was even more empowering and incredible than those more negative things."
"I don't really know how to move beyond this sadness."
"We will try again, soon, I hope."


Eight clients have traveled this journey of loss in the past month. One woman is going through her second loss since last October, when she lost twins. Some have gone for a D&C instantly. Some have waited for weeks for everything to happen naturally. One travelled to Ontario and miscarried in her mother's home. No one had a miscarriage that was what she expected. Each story is completely different.

Sometimes, a woman and her partner must travel this journey alone, because the pregnancy loss can happen so early that she's not even seen her doctor or midwife. She doesn't know where to go, what to do. The Early Pregnancy Loss Clinic at BC Women's Hospital offers medical care, support and guidance, and Family Physicians and Counselors can help with the changing emotions that follow miscarriage. But, often, my clients call me because they know I've been through this experience personally, and have gained wisdom from the stories gathered from other women. Each woman knows that I will focus on her alone and listen as she tells her story, listen when she gets angry, and listen when words just won't work any more.

We hold our stories up to the light. We tell our stories to each other. We won't forget.

To start, this is my story. I never had a hard time physically with miscarriage. Both times, everything came away quickly, deeply, with me sitting in a red bath at home. Thankfully, I never bled too much nor too long. The physical aspect did not scare me. It felt right, complete, connected. I healed gently.

But, the first time I miscarried, in March 1986, all I could think was - Where did the lost spirit go? What was the spirit's purpose? Would it ever come back again? Was this its only time here as a physical being? I couldn't get the image of the lost spirit out of my head. I needed some meaning. And I was lost.

My husband couldn't help me. He wanted to help, but his loss was different, more theoretical. I needed stories told by women. I asked women for their stories of pregnancy loss, and heard nothing. It was still a time of whispers - "I hear she lost her baby, poor thing." Only my mother told me her stories of loss, why there were five empty years between my brother and me, and why I had a mental snapshot of her being carried out of our bathroom by large men (another pregnancy loss after a car accident when I was two). Only after I'd heard all her stories was I able to integrate my experience and find understanding.

When I miscarried a second time, in March 1988, while I was still breastfeeding my second baby, I was relieved. Yes, relieved. I admit it. I was so thankful that I wouldn't have to give up precious time with my son, precious time with my daughter. Did this lost spirit come and go just to help me decide that I only wanted two children? I really didn't feel any sense of loss. I looked at guilt and chose not to let it in. The miscarriage felt necessary, right, complete, connected.

Those losses eventually merged with the intense joy of being alive, being able to look up at the sun shining through the trees, knowing that everything is connected. We are all connected.

Now, all these years later, in March 2009, eight women called to tell me their stories of loss. Just like all the women who have come before them, they continue to tell me their stories, so we don't forget. We hold each other up to the light with our stories.

Each telling and retelling makes life feel more real, more exquisitely beautiful for its fragility.

The light is round like a ring
and we move within its movement.

- Jacquie Munro, Vancouver Doula, Slow Birth, Slow Planet

Moleskine (or remedies for Slow Pregnancy)

It's interesting what the body does to us in the last weeks of pregnancy. Even the most active woman feels the slow pull in her mind and body, urging her to wind things down. Slow Pregnancy has struck!

Sure, you still feel motivated to go for long walks (more slowly) and swim (more leisurely paced) or even join a group on a Thursday evening (and do yoga), but your mind and body are slowly, slowly pulling inward, demanding attention.

In the past week, women have called to ask if they're losing their minds, asking what just happened to their memories, their attention span, their drive?

"Remind me what week you're at?" And the answer is always somewhere in the 30's.

The body does a wonderful job of making you focus on the internal work of pregnancy, whether you like it or not, in the third trimester. At 20 weeks, the thought of working right through to the end of pregnancy seems like a great idea. The pragmatic approach will save precious sick days or maternity leave time. But as week 32 approaches, the mind starts to turn its attention away from work projects, away from deadlines, away from stress and pressure, and there's a sneaking suspicion that, just perhaps, work isn't quite so important any more...

That's when I get the phone call. "My boss is on my back about the deadline, but I just can't be bothered. I can't even remember what I'm supposed to do next! There's this pile on my desk. And I'm the project manager! I'm looking at my calendar, and nothing makes sense. What's wrong with me? I just keep bursting into tears!" Nothing wrong here, it's just the last trimester, and big work is happening inside. It's time to listen to the body, and start slowing down.

It's quite amazing how the body manages to quietly work its magic. If there's too much stress in a woman's life, and the voluntary slow-down doesn't happen, eventually there will be a physical manifestation that will force her to slow down, leave work, or change to part-time or working at home. It could be a rise in blood pressure, or some body part "out of whack" requiring daily physiotherapy. The body has its ways of demanding attention. It always manages to get each of us to slow down. Slow down.

One engineer, working in an otherwise all-male office, developed high blood pressure and memory loss that scared her in her last trimester. This normally "together" woman burst into tears at her midwife's office, unable to even call her boss to say that she was going to have to stop working. Her midwife offered to call her boss for her. The woman was so thankful, but felt so guilty and overwhelmed that she wasn't able to even make a phone call. "Stress, combined with low hemoglobin and high blood pressure? at 34 weeks?...it'll do it every time. Don't take on any guilt, you hear?" (In those days, Outlander was my prescription for her to read. Today, the equivalent would probably be Twilight. Trashy, easy to read, and great at lowering blood pressure if combined with your feet up on a good comfy sofa.)

And what about the memory loss? Studies have shown that, yes, you do lose some brain cells when you're pregnant. But, here's the amazing thing - mothering increases the neural pathways in our brains, making us unbelievably capable of doing a million things at a time. You just need to give it time. Let it happen slowly. Brains don't change overnight.

So, please be gentle on yourself, pack away the guilt, let the memory slide, slow down to Fiji time, allow the body and mind to complete the inner work of pregnancy. Be just a little bit less conscientious at work, a little less driven in the gym, a little more giving to yourself. Ask for support from those you love, from your friends, from your caregivers, or find professionals who can help you, physically or emotionally (your local hospital or health unit are ready and willing to help in whatever way possible, for free.) Read more junky novels, watch the clouds pass by, sit on a log and watch the waves...

Soon enough, you'll be able to multitask and work out, but AFTER the baby is born. There's plenty of time to be sucked into the rat-race of 21st century life, so please resist the urge to speed up for as long as possible once you have your gorgeous baby. Yes, please be slow and easy on yourselves. We are beautiful imperfect creatures who deserve hours of self-deprecating laughter each day.

P.S. I think I forgot to say something about those lost brain cells! Right...now I remember...you probably won't be able to remember a long list of things any more. But, that's okay. There's an easy way to overcome your memory loss. Just slip a little Moleskine lined journal into your purse so you can write down all your "notes to self", or ask for an iPhone with iCal as a group shower gift (I need BOTH because my brain is positively happy mush) and you'll be right back on track for the rest of your life. Right?

- Jacquie Munro, Vancouver Doula, Slow Birth, Slow Planet

There's always room for more babies!

Please email me to see if I have any openings for April, May, June or July. It never hurts to ask! Some babies have come quite early (amazingly!), so I have some emerging space available. Right, lots of room on that comfy sofa!

We'll be off to slow travel through Europe, while eating slow food, from the beginning of August until the first week of September. While I'm away, my backup doula will be available to field any questions or concerns...and even attend any early births!

I'm fully available for new clients with due dates after September 8th. Please remember that I ALWAYS have room if it's your second (third or fourth!) baby, or if you're a returning client.

- Jacquie Munro, Vancouver Doula, Slow Birth, Slow Planet

Dare to be different

Okay...this is starting to become a real pattern...

After each birth, the lovely nurse sighs and says to my client, "I haven't seen a birth like that in ages. Thank you!" Well, actually, yesterday's quote (by a British nurse) was, "I haven't seen a birth like that since I came here!"

Then, I ran into a nurse who had helped us at a birth last week, and she still was in shock that my client gave birth standing. "I tried to get her back onto the bed, I ASKED her to get on the bed, but she just didn't! I had to think, how am I going to do this, where's my stuff? I hadn't done anything like that before!"

"Oh, come on," I said. "You're creative! Wasn't it good to think outside the box at work for once?"

"No!" She was laughing while she said that, but she really had been outside her comfort zone at the birth. Why didn't she embrace something new and dare to be different? (Understand that she is otherwise a fabulous nurse, and really never let on that it was outside her comfort zone to my client...great diplomacy!)

I checked my client stats since October 2008 (26 births). There have been only three cesareans (11% - one breech, one face presentation, one true fetal distress). The rest have been water births, standing births, hypnobirths, squatting births, hands and knees, side-lying, etc. Some just had one vaginal assessment, some none at all. A few (18%, which includes the cesarean births) had epidurals (that had been their plan all along). The rest (82%) used water, movement, singing, TENS, dancing, and, for some, just a little bit of nitrous oxide gas, to help them through labour. Their ages ranged from 30 to 50 (yes, 50!)

Isn't the hospital epidural average well over 80%? (Must check recent stats...) Anyway, it's not 18%!

How do we do it? Well, I do have clients who are able to eat well, go for long walks, stay fit. But they're not really much physically different from most women. And...they all have their own anxiety, fears, and baggage. Some have battled emotional demons, and some have overcome physical and sexual abuse.

What I offer is the long, slow approach. I try to work with my clients over many months (slowly building trust), talking to my clients about the most recent research on mothering, birthing, parenting. I find out about their lives, what drives them, what challenges them. I ask them to call me whenever they are worried or scared, or whenever they just want to have a good chat. A phone call that starts with us talking about diapers, might end in her telling me that she was abused as a child, or has battled depression, or that she hasn't yet told her midwives that she's seeing a psychiatrist and is on medication. I help my clients to feel and know that they are safe. We trust each other.

One recent client went from "I really want an epidural" at our initial interview, to using hypno-birthing...and laughing and chatting as she entered the hospital at 8cm.

Another client went from having post-traumatic stress symptoms and battling depression and anxiety, to a home birth with joy.

And yesterday? Well, this woman had a lovely slow birth. She was another who dared to be different. After about 14 hours of deny-it cramping, she asked me to come just after 2am. We spent the next 9 hours with her on the ball, in the bath, in the shower, back on the ball, doing walkabouts, climbing the stairs, lunging, swaying, swirling. That's 9 hours. No, we didn't bolt to the hospital. She was confident in her and her baby's safety. She had a loving partner who stuck by her through it all (and who I could reassure throughout). I talked her through most contractions (except in the bath). "Soft...you are safe...your shoulders are loose...your muscles are melting...your bottom is loose...baby is wiggling down...your hands are soft...your face is soft...your legs are heavy and warm...soft..."

We waited until we had counted off at least 5 hours of good regular contractions under 5 minutes. We waited until she'd had significant bloody show (not mucous plug!) We waited until she'd had over 2 hours of self-described "8/10 power" contractions (up until then, her 3-minute apart contractions had been at 5-7/10). We waited until she was moving, almost dancing on her tip-toes during each contraction. We waited until she was deep in a trance of endorphins. We waited until she was just beginning to feel a hint of pressure in her bum from the bulging bag of waters (we didn't wait until it broke, but we could have waited, if she wanted.) We waited until she said she was ready to go to the hospital.

Then...she said the word, and we were ready to go. But then, we had to wait until all the shrieking children in the school-yard across the street had gone back into their classrooms after recess!

Okay...to the hospital. 7cm. That number scores us the good rooms upstairs. Into the bath, then walkabout, the birthing ball...and back into the routine that we had at home. "Soft, you are safe, your baby is safe." And infinite patience. And a partner by her side. Throw in a lovely British nurse who moves silently and gently. Add a young family doctor who intuitively respects a patient's need for autonomy. And then we stay by the woman in labour, and trust her, and trust her baby, and trust her body...and wait. One hour. Slow. One hour. Slow. One hour. Gentle. Slow. And, right on cue, she starts to feel the baby coming. An hour and seven minutes later, out emerges a beautiful pouty face...then oh! a little hand...then a smooth vernix-covered body. Hands reach down and baby Maggie is on her mum's chest!

And then it comes, the nurse shining and smiling, finally happy..."Thank you. I haven't see a birth like that since I came here!"

That was a first baby who dared to deny the hospital statistics. She had laughed at the almost 30% cesarean rate, the 90% epidural rate. She was undisturbed, unmedicated, and was given a slow and gentle birth.

We owe it to our children to dare to be different. This changes lives, and it IS worth the effort.

- Jacquie Munro, Vancouver Doula, Slow Birth, Slow Planet

Slow Escape

One thing that I love about working in the 'birth business' is that I don't have a structured schedule. Mine is more like a feast or famine schedule - no babies for two weeks, then BAM! four babies in three days. It certainly makes for an entertaining life.

Babies come whenever they like, and they always seem to come in a clump. Yes, a clump. "Group" would be the wrong word. A group feels orderly, predictable. But a clump - well, that sounds like just the right word for how babies arrive in the world. They seem to get a signal that NOW! is the time, and they all come in a clump, all jumbled together, jostling for position.

I attended five births the other week - five glorious, slow births. These babies didn't watch the clock (neither did their mums and dads and caregivers), and certainly didn't concern themselves about my lack of sleep. These babies came in their own time - one gently in the water, one with her mum's feet firmly planted on the ground, and a few with grand flourishes. But, they all came at their own pace - slowly, deliberately, safely. These babies taught us patience, and more than a few hard lessons.

So, when this recent clump had all arrived, I jumped at a chance to go with my husband on an impromptu visit to a small island close to our home. I didn't have any babies due for a week or two, so I could breathe easy, and run away.

We walked onto the ferry as the sun set, and, fifty minutes later, walked off the ramp into the darkness, carrying our backpacks. We didn't know exactly where the local Inn was, but the clerk had said, "You'll find it." We followed a woman who was pulling a suitcase on wheels, jittering over the rough road, hoping that she was going to the Inn. We might have been following her to her cabin, but we didn't mind. We were living slowly.

Sure enough, she drew us through wrought-iron gates to the Galiano Inn, complete with cedar shakes, tall tree posts, and, through the door to a vaulted space with a stone fireplace. We had arrived.

The next morning, we woke up to see the sun rise over Mount Baker, watched the large ferries plough through Active Pass, and laced up our boots for the day's walk. We had left our car, and our bikes, at home, opting for an even slower pace around the island. After breakfast, we walked to the Bluffs, explored the cedar forests, waved at llamas, watched the eagles soar, checked out the local organic food store, and, 15 miles later, returned to the Inn for a good soak and a read (about the Camino de Santiago de Compostela.)

The next day dawned with sunlight streaming across the harbour. Most of the other people staying at the Inn would be spending their day in the spa having hot stone massages and facials. But, that's not our style. So, we told the clerk that we'd be hiking to Montague Harbour. She had a quick intake of breath, "Oh, there's some wicked hills! You're walking? Really?" Being a mapmaker's daughter, and daring enough to interpret those lines on the map, I took a guess and said, "Let's head clockwise. I bet there'll be less hills that way." (Boy, was I gambling!)

Am I glad we didn't go the other way!!!

As it was, the hills were still a challenge. But, we just kept in mind that we were on foot, and not grinding our way up those hills on our bikes (or on the Santiago de Compostela pilgrimage!) We had time to stop, think, listen to the wind in the trees, watch the misty rain fall, feel it on our faces, wrap our scarves more tightly, gaze at the sandstone cliffs and the erratics at their feet. It took two hours to hike to the harbour, where we ate caraway cheese and stone fennel crackers on the shell beach. We didn't meet any other pilgrims on our trail, just a lone cyclist on a 40 degree hill, pretending to be Lance Armstrong on Mont Ventoux.

After four hours on the hike, we could feel each muscle working to keep us going. No pain, just good hard work. Our legs seemed to work independently, keeping pace with each other. We held hands at times. We tucked out hands in our pockets when we needed. Then we saw the rain heading our way. It came as a mist bank, white and blanketing the hills. We knew there was a pot of tea close by, at the Market Cafe, and reached the cafe just as the downpour started. A roaring fire, four throbbing legs, two cups of tea, and chocolate. Slow hike rewards!

An hour passed, and the rain softened. We ran across the street to the locals' trail to Sturdies Bay, only two kilometres away. This was our third passage of this trail, so we felt like we knew its secrets already, knew where the fern grove was, where the boggy sections were, where the people were gathering firewood, where we needed to take small steps to easily climb the steep sections. We felt like we belonged.

At the end of the trail, and around the corner, we treated ourselves to a visit to the local bookstore. It's one of those places that has reviews glued to the shelves - "John's pick", "Jennie's favourite". I bought "French Toast: eating and laughing your way around France." My husband bought "The Wisdom of Donkeys: finding tranquility in a chaotic world." Two slow life books.

Later that night, after we'd left the island by ferry, and arrived home, fully refreshed, the stragglers of the baby clump decided to arrive. Two babies came over the next three days, one after the other. We'd only been home for five minutes when the first phone call came. "Jacquie, I think the baby's coming!"

I smiled, changed out of my hiking boots, put on my birth gear, and headed out into the night. I loved our Slow Escape, but I also love Slow Birth (and those unpredictable clumps of babies!)

- Jacquie Munro, Vancouver Doula, Slow Birth, Slow Planet

Slow Denial

I promise my clients that I will always tell them the truth about what's happening during pregnancy and labour...but I must admit that I do downplay things during prelabour. Now, this is only to help the clients to make it through the crazy unexpected early stuff that really, REALLY, isn't labour.

This is the denial phase of labour.

Too often, people have the TV image of labour - your water breaks, off you go to hospital, get the drugs, and the baby is born on the bed (surrounded by gowned and gloved anonymous people). This may be what 90% of births are like...but they're not the kind of births that my clients have. They dare to be different. They live in denial. This is Slow Birth at its best.

Grandmas-to-be call and inadvertently pressure their children, "Why aren't you at the hospital yet?" Friends call and say, "I had my baby last month, and it was hell. Just go in now and get the drugs!" Labour will never progress with all those phone calls coming in. So, please, unplug the phone. Or, at the very least, record a new voicemail message that says, "No, we haven't had the baby yet, and we'll record the great news as soon as we meet our baby!" Then, turn off the ringer...and live in denial. (Oh, and you can strap on your TENS machine at this time, if you like!)

Denial works! One woman had her mum over for lunch when she was in early labour, and didn't even tell her. Then she headed out to rent a DVD, and planned to watch it that evening...and didn't even believe it when I showed up and said, "Now - you're really in labour. You'll have your baby in the car if we don't hurry!" (She had her baby a couple of hours later.) Denial worked so well for her (too well!) that we didn't have to play that game when she had her second baby.

A wonderful client had her baby last night (Tuesday night). Her "denial phase" started on Monday night. She called to say she was having mild cramps at 8:15pm. Now, I had a feeling that this might morph into labour, but I wanted her to be able to have a good night's sleep. So, I said that this could become labour, but it also could just be part of the normal changes that occur in the last few weeks of pregnancy. "Deny it, have a lovely bath, then climb into bed," I said. "This might stop, and the baby might not come for another week." She answered, "I do denial well! Sounds good to me!"

The next morning, she called to say that she'd done a great job of denying the contractions through the night, and managed to sleep quite well. Yes, the contractions had come every 10-15-20 minutes, but she pretended that this was totally normal, and she didn't waste any emotional energy on the contractions. By morning, she was feeling good, sounding bright and energized. Denial had given her a good night's sleep.

To make sure that she didn't have to do another night in labour, I suggested a good long bath after lunch. Her husband turned on music, and she had relaxed in the tub and chatted and laughed with her husband and sister. They made a great memory. They were living outside of time. "The bath was a turning point," said her husband. They didn't have to deny the labour any longer. After the bath, the contractions were 5 minutes apart and getting stronger and longer.

Are you noticing that this is a Slow Birth story? By playing the "denial game", they didn't focus on time, and allowed the body to rest and do its thing at its own pace. They were connecting as a family, and rediscovering that it's okay to trust the body's rhythm.

After the bath...after becoming so relaxed and soft, her labour began with strength and power. It wasn't long before we all headed to the hospital. The denial phase had lasted about 18 hours. We didn't count that as part of her labour. We started the official labour clock at 2pm. She started her labour happy, rested, emotionally strong, thanks to denial.

For the remaining 9 hours there was no need for denial. She could just inhabit her labour and let it advance slowly, at its own place. She danced, bathed, lunged, yoga'd, bounced the ball, stomped her feet, and sang. She only had one medical assessment during all that time. No one declared her "fully dilated", no one offered drugs, no one made her get on the bed...she just WAS in labour, without time, without judgement.

And her baby came with joy, her two feet planted on the ground. She was lovingly supported by one proud and amazed man, and four smiling women. Yes, she stood to have her baby, and clutched this little girl, called Lily, to her chest, laughing, "I don't believe it!"

Slow Denial had worked its magic!

- Jacquie Munro, Vancouver Doula, Slow Birth, Slow Planet

Prodromal Girls (or how to have the perfect Slow Birth)

Prodromal labour was the name of the game this week. Four babies were born, who each gave their mums long prodromal labours (and some long active labours, too.) None of the births were "easy" this week. But they were all amazing and beautiful and triumphant.

What's prodromal labour? It's Slow Birth at its ironic finest. It's that part of birth that isn't really labour yet (patience, patience). It's the body trying to deal with something without making it too challenging for the mum. But, the body doesn't realize that the mum has a brain (a very intelligent and 21st century brain) that continually tries to figure out what's happening...why is this taking so long?...why am I not having a 2 hour labour?...when will it pick up?...why?...how?...when? All those questions are exhausting. Prodromal labour demands that we honour the needs and rhythms of the body, and shut down the thinking brain. Prodromal labour forces the reptile brain to kick in. My job is to remind the mum that she must trust her body and baby...they both have their reasons for taking their time.

To us mere mortals, long prodromal labours can be challenging and undecipherable. However, to the four babies this week, the slow progress made perfect sense. They tried to give us their messages, and we did our best to interpret them. We promise to remember the lessons we have learned this week, and listen even more closely to the babies in future!

So, what was going on for these babies?

Baby #1: "Ooops...Who knew you couldn't come out forehead first? No one left directions for me! I thought it was a creative option! (They had to back me up and take me out, OR-style. Mum and dad didn't fuss about the change in plans, because I'm just too darned gorgeous!)"

Baby #2: "Hey, mum, I had my hand smushed against my face! And that cord kept getting in my way! I'm glad you gave me time! (I had fun being born in the water, it really helped make more room for me, and I made sure I slid out without tearing my mum, and, and, my hair was washed as I came out!)"

Baby #3: "Okay, if you only knew that I was 9lb14oz, you guys would have given me a break and been okay with the hours that it took me to figure out the best way to slide into the world! (Those people catching me all thought my shoulders would get stuck, but nope, I just needed to take my time so I wouldn't hurt my mum.) "

Baby #4: "Now, you have to understand what it was like in there. I had to twist my head this way, tilt it to the side a bit, just like that, then I thought, maybe, just maybe, I could mold my head into a banana and slide out mum's hip. (Oh, I forgot to say "Thanks" to the obstetrician who used her tiny fingers to turn my head into the right position. It was a breeze after that!)"

Now...we're waiting for Baby #5, who has yet to arrive. This baby may or may not be very overdue...who really knows for sure? We'll just have to wait and see...

- Jacquie Munro, Vancouver Doula, Slow Birth, Slow Planet

Slow Birth Breech

"Can we stop on the way and pick up a Big Mac?" asked the woman.

"Sure," said the man, as he turned into the drive-thru...

I was standing at the hospital entrance, wondering what was taking them so long. M was my very first client, and she was in labour. Her baby was frank breech (that's bum first). It was 1988.

M's family doctor was driving her to the hospital because they couldn't reach her husband at work. (Remember, this was life before cell phones and voicemail.) Charles, the doctor, worked out of a little home office in a small beach community, only minutes from her home. They were friends. She told me that he used to be a specialist in rural BC, hence his ability to roll with whatever came his way.

So, back to the scene. The doctor's car pulled up to the Emergency entrance, and out tumbled my client with a half-eaten hamburger in her hand. He parked the car and followed us into admitting.

(Okay...wait just there! Do you think this scene would EVER happen today? It was laughable then, but not completely absurd.)

We arrived at the maternity ward, and settled in. We could see the beach and the sparkling ocean from the window. There was a rocking chair in the corner, beside a full-length antique mirror. There were no monitors or equipment in the room. The nurses would set up in the hallway and only roll in the carts just before the baby was born. There was no disturbance.

"These contractions are nowhere NEAR as bad as our rowing sets!" M had been on the Canadian national women's rowing team. "Our training sessions were brutal!" (Perception is everything in birth.) I stroked her and she moved her baby down.

Now, I don't remember how long it was before her baby was born, but I do know that I was still breastfeeding my one-year-old son, and I didn't miss a feed!

There was no fear in the room, no increased anxiety because her baby was breech. The birth was allowed to happen in its own time. It was graceful and slow. The doctor just lifted up the baby's body as it was born, and out popped the head.

It

was

that

simple.

Now, you have to remember that the family doctor used to be a medical jack-of-all -trades in Northern B.C. He knew what to do at a breech birth. He knew that he had to trust the woman's need for food in labour - it would give her strength. He trusted birth.

Think about it!  That was the very first birth that I attended as a doula.  It was the first of so many Slow Birth lessons.

Over the next decade or so, I attended many breech births without worry. I knew I could trust the caregivers to be skilled at any and all maneuvers required. Dr. Woolley told me that he loved breech births. "At least you have something to grab on to!" Dr. Bagdan told me that breech births are often much less painful - "It's a soft bum, you know," and I remember seeing him catch two breech babies gloveless, just because they'd always come so fast (those two mums were breech themselves!) I also remember Dr. Thomas sitting on his hands and saying, "Jacquie, the key to breech births is to watch the flow of the labour. If the labour continues to progress without a hitch, then it will be fine. But, if the mother senses a block, then we'll do a cesarean when she gives the word." I saw him catch so many breech babies, and only one woman had a cesarean after she said, "It's not going to come." This was Slow Birth. It honoured the rhythm and messages of the body.

I don't know when that breech wisdom died, but after we lost Drs. Woolley and Pendleton, and Dr. Thomas retired, and the breech trial stopped vaginal breech births in their tracks, that was the end of it.

Sure, there were a couple of brave doctors (Go, Henry!) who would agree to attempt a vaginal breech birth, but that would be only if they were on-call on the day that a woman went into labour. Timing was everything - if the "breech" doctor was away, the baby would be born by cesarean.

A few years ago, my daughter asked what her options would be, if she was pregnant and her baby was breech..."Well, I'd have to drive you to Ina May Gaskin's "Farm" in Tennessee, or fly you up to Yellowknife to see Dr. Kotaska." (Recently, I told a doctor that, and she laughed, and said, "Yes, I'd do the same!")

So, you can imagine that I was thrilled to discover that BC Women's is hoping to start a Breech Clinic, which would ensure continuity of message, informed choice, and 24/7 vaginal breech capabilities. What a wonderful way to reduce cesarean rates! I hope the clinic opens soon.

I only wish that some of the new doctors could see how it used to be done - slowly, simply, and with such infinite trust in the body. Breech birth - the Slow Birth way.

Here's hoping that we can reclaim the old wisdom.

(Update April 3/09: Any woman in the BC Lower Mainland whose baby is breech, and wishes to explore the option of a vaginal birth, and whose current physician does not offer vaginal breech births, can now be admitted to BC Women's for care by a "participating" obstetrician. Thanks to all those involved for this fantastic policy change!)

- Jacquie Munro, Vancouver Doula, Slow Birth, Slow Planet

We are not our bodies

We are not our bodies.

As one who lives with birth,
I am at peace sitting at the doorway between life and death,
sitting beside each woman as she discovers the infinite.

At each birth, I must acknowledge that the doorway is open.
I honour it, thinking,
"This may be the day,"
and I am at peace.

I still remember being
in the last few lightning flash moments of labour
with my son,
thinking, with clarity,
"Death is a viable option here.
Perhaps the midwives will consider that."
But they didn't hear my thoughts, and my son
was born
onto my leg, and peed
all over me.
Our laughter seemed to make his wet skin shimmer.

I have been in a room, filled with Sufi women
mourning the loss of a baby
reciting the chapter of Mary
and hearing their chanting
knowing that the root of the word "rahim" means womb
being lifted up by their sounds
that rise and fall like the ocean
that recreate the sound of the beginning of time
the divine feminine
the womb

I wanted that day to last forever.

To our western minds,
how can a day of mourning be so breathtakingly
beautiful?

To our western minds,
how can we accept the knife-edge of pain and ecstacy
that exists in birth?

We are not our bodies.

- Jacquie Munro, Vancouver Doula, Slow Birth, Slow Planet

Slow Biking on Valentine's Day

I know this may seem off-topic, but I wanted to write about yesterday's outing (no births!). The sun was shining, it was Valentine's Day, and I'd just gone with my husband to buy presents for each other at MEC (no, not chocolates or flowers). We found a new red windjammer for me, just like the one I had when I was little, and black leg warmers (woohoo!) for my husband. Then, we headed out on our first long ride of the new year.

We talked about Slow Birth ideas, chapter topics, debriefed from recent births, and had a long ride around False Creek, through Gastown, around Stanley Park, then back to Granville Island for lunch at the best seafood shack ever, Go Fish! (for a counter-balancing calorie intake), then rode back up the hill to our loft.

What struck us were the number of people enjoying a slow day out in the sunshine (remember, it's February and freezing cold). The memories that stand out are:

• Dragon Boats in False Creek filled with men and women wearing multi-coloured puffy down coats, focused on the perfect unison stroke,
• a man on rollerblades near the 2010 Olympic Village, pushing his son in a stroller, with a tricycle balanced on top, followed by mum on a bike,
• an old man riding his unicycle down a hill, holding a coffee cup in his hands, for warmth,
• three homeless men, in three different parts of the city, on bikes loaded with recyclable bottles, all wearing bike helmets,
• a group paddling their outriggers near Science World, shouting and laughing,
  
• a man wearing a baseball glove, pitching his ball into a brick wall in the heart of the Downtown Eastside, watching to make sure he doesn't get in our way as we ride,
• a family on tandem bikes, with flowers in a pannier,
• 5 groups of oddly-dressed people, running fast, carrying compasses (must be orienteering for team-building),
  
• serious rowers gliding through the water at Coal Harbour,
• a teenage goth carrying flowers down a back lane,
• a woman quietly, happily, digging in the soil, creating a garden beside her solitary old house in the centre of town, amid the noise and cars,
• four colourful pseudo-pelotons spotted around the city, dominating the bike lanes at a "slow" 40km/h,
  
• the look on a new mum's face, just after her baby threw up all over her after a feed,
• a mum carrying her newborn in a hug-a-bub, walking up the ramp after buying fish from a boat,
• people working on their guerrilla community gardens, wiping dirt off their foreheads as they chat,
  
• families, pregnant couples, babies, walking, riding, talking English, Spanish, Farsi, French, German, Japanese, laughing.

But the most amazing thing is that we connected with each one of these people on our bike ride. Our eyes connected, we smiled as we passed, we called "Hello!", we waved...

The connections are what count as we travel through our lives, and I think we're all doing a pretty good job of it in our little corner of the world...

- Jacquie Munro, Vancouver Doula, Slow Birth, Slow Planet

"I'd like to order one epidural in the parking lot, please"

During our initial phone call, many first-time mums nervously laugh, then ask me if I can just order them a fast birth "and one epidural in the parking lot, please." It sounds like a drive-through order.

"Why?" I ask myself. Really fast births don't allow the body to churn out all those wonderful pain-relieving endorphins (boy, do you want them!) Fast births don't allow any time for the brain to keep up with what the body is doing. Actually, my least satisfied client had a 45-minute labour and birth. She said, "I waited 40 years to give birth, and THAT'S IT??? It was so fast, I missed it!"

Fast births may increase your level of fear, or result in a greater likelihood of heavy bleeding. If your body naturally gives you a fast birth, that's just fine.  But, I wouldn't willingly force a normal labour to move faster than it should.  And, for those wanting to order "one epidural, please" in the parking lot...with a fast birth, there's just no time.

So, what to do? Wouldn't you rather have a birth that's just right for you? Not too long, not too short, just right. Kind of like the chair, or the bed, or the porridge in The Three Bears. Just right.

Isn't a lovingly prepared meal that's simmered on the stove much better than fast food? It's harder work, there's some prep time needed, it takes more time to cook, but it's SO worth it.

We're given nine months to prepare for birth - a good long prep time. But so many people just fill that time with classes and shopping and renovations and new cars and new homes, and paint (always paint.) All this, for one tiny being who just wants a warm body to hold him, and a couple of breasts!

Women often forget to take long slow walks on the beach, doing the inner work of pregnancy. Old fears, habits, and family dynamics bubble up as each week progresses, and need to be addressed. After twenty-one years of attending births, I see that unresolved issues can often stop a labour in its tracks.

One woman made it easily to the pushing stage, then everything stopped. No matter what she did, there was no urge to push, nothing, for two hours. After a while, the doctor said, "We'll just leave. You might be worrying about something, or have something to work through. Why don't we leave you alone with your partner for a while? Just come get us when the baby's coming."

We were called back half an hour later. She had been holding onto a secret since the age of 15. Once she released the secret to her partner, the baby came in just a few pushes.

The hormones at play during late pregnancy and labour have taken millions of years to develop to perfection. Hormones soften the body, making the joints feel like they are attached only by elastic bands. The uterus becomes more responsive, letting each woman know if she's done too much that day, or not had enough water to drink. Women start to wake up more frequently in the middle of the night, in preparation for those moonlit nights with the baby.

The baby is an active partner in the birth, burrowing and stretching. One woman the other day said that she kept imagining a cartoon mole, pressing and wiggling deeper. Other women have said it feels like a pearl diver, pushing off the side of a rock, diving deeper.

Each labour takes as long as the body needs. Time is needed to allow the hormones to work, in concert, undisturbed. If there's a slow beginning to labour, the body has its own reason, or the mind is keeping a lid on things.

Yesterday's birth was another amazing story of trust and slowness and, ultimately, surrender. (Months earlier, she had been interested in that epidural in the parking lot, but she had educated herself, and now she wanted a slow birth.) She started to feel things a few days before the baby finally came. With the help of long phone calls to me, pep talks, warm baths, lots of distraction, and good food, she made it through the days.

"This is not labour yet," I kept reminding her. "Think of these infrequent cramps as your new normal." She used her hypnobirthing techniques of relaxation and fear-release to accept the pace of her body and baby. We talked about the logic of the body, what to expect, how endorphins work, how all the hormones work in concert to move her through to the birth. She leaned on her loving partner to lift her spirits. When he needed a boost, he called me. "Jacquie, what do I do next?"

Then, in the afternoon of the second day of prelabour, she called again. "I'm getting discouraged." She was finding it hard to surrender to the process. I encouraged her to move, to crank up the salsa music and dance, swirl her hips in the shower, to let go. I encouraged her to trust her body, to release any tension, and let the baby come.

An hour later, I called back, because I had the feeling that something new was happening. She said, "Something's happening!" (Yay ESP!) So, I drove over quickly. She was really in labour now.

I found her at home, smiling and calm. "I'm at peace." Her dancing and swirling had moved her into active labour. She was finally able to accept, and surrender to, the "surges" that were coming every three minutes. Within an hour and a half, we were at the hospital. She was already 8-9cm, and ready for a lovely soothing bath.

"Gotta get one of these tubs," she said, as she laboured in the water. "I feel confident. I feel safe. I feel secure," spoke the hypnobirthing tape from the corner of the room.

Four hours later, the baby was born. Quietly. Slowly. Gently. A lovely pink bundle of a baby girl.

Slow birth works, just like slow food. Plain and simple. Just a glorious mix of natural ingredients, without any additives -and so very, very good.

- Jacquie Munro, Vancouver Doula, Slow Birth, Slow Planet

Slow Birth > Mt Kilimanjaro

"Jacquie!" says the voice in the night. "I'm in pain."

It was 1:38am and I had a feeling this wasn't going to be her time. "How often do you feel what you're feeling?" I asked. "About every 10 or 20 minutes. But it really hurts!"

These night-time prelabour calls come often and, just like a baby needs to be calmed before going back to sleep, I just need to offer calming words to each woman, then sleep will come to her soon (after a good long bath). I remind her that the process of having a baby takes weeks, and this is just part of the body's way of preparing. The hormones work even better if she's soft and warm and sleepy...so into a bath, then back to bed. Sleep.

Days later, the real labour call came at 11:27pm at night - from her husband. "She was having a bath again, like the other night. But this time, she leapt out of the bath and started crying out!" Ah! It's her first baby, but when I hear a man's voice, I know I have to fly over. It's time.

Midnight - Contractions are 3 minutes apart and strong. She's moving, standing, sitting, breathing, swaying. She feels hot and cold. She loves when I shake her hips and the power slides down to the ground through her feet. "Jacquie! These aren't contractions! They're expansions!"

"I need to walk!" and she climbs the stairs as each expansion comes, marching back and forth through the house, hands on hips. She's amazing. "Hoo Hoo Hoo..." She runs.

In a Slow Birth, we trust the labour to tell us what to do. We're not looking at the clock (I don't even own a watch), we sense the increasing rhythm of the labour. The signs are always there - the blood (that's good), the clothes being stripped off (oh, so good), the nausea (it will go as soon as the stomach empties - quickly!), the shine on the tummy, the glowing face, the knees, and then...

"Pressure in my bum!"

We arrive at the hospital at 2am, after a safe drive through the empty streets, cool air fresh on her face. Almost 8cm, melting to 10cm. She's ready to push within half an hour.

Birth is sacred, and this birth is fresh and new, so the rest of the birth story belongs to this couple, crazy and hard and slow...and proud.

"Bonjour, bonjour!" I leave them three hours after the birth, curled around each other, the baby at the breast. "That was harder than Mt Kilimanjaro!"

- Jacquie Munro, Vancouver Doula, Slow Birth, Slow Planet

Slow Birth is born

Maybe I'm just a little slow...but I've finally decided that I have to act on my decision (2004) to start focus-writing on Slow Birth (think slow dancing, slow cooking, slow kisses, slow lane, take it slow, baby...)  Don't you just take a big breath and sigh when you read those words?

I loved reading "In Praise of Slow" by Carl Honore, and discovering the Slow Food and Slow Travel movements as they emerged.  We had always raised our children according to the "slow" philosophy.  We talked, we listened to music, we read books together, and my husband and I kept our lives in pace with our children's development - we kept things slow, and the family flourished. When the slow movement began, it was nice to see that other people were discovering this way of living.

Every week, I still make my slow-cooked soup, just like my mother. I treasure my red Staub Cocotte and joyfully watch my family eat my lemon-braised chicken (then love to hear my brother talk on the phone about trying to replicate the tastes in his own home in Oregon). We eat local produce (carrying our bags to Granville Island market or riding to outdoor summer markets) and try to do our best to honour the 100-mile diet (though, we're gentle with ourselves when we fail). 

Now that our children are all grown up, we live in the centre of it all, live small (in a loft), ride our bikes, and walk every day (I love walking to client visits, or walking through leafy Shaughnessy on my way home from a birth). When we're on holiday, we don't try to "bag the sights". We take our holidays slow. This summer, we'll be hiking the Scottish hills, riding our bikes across the Provencal countryside, and sleeping in stone-built cottages for a week at a time - exploring new places at a snail's pace. We'll carry our reusable bags from shop to shop in Montmartre (thanks to Clotilde for telling us where to go) and take our baguettes and veggies home to our flat, then bike ride through Paris using Velib.

So, it's only natural that I would try to help my clients (okay...you're seeing my bias here) to have a Slow Birth.  Slow Birth honours each woman's hormonal rhythm, allowing for the ebb and flow of labour.  If there's a plateau in labour, Slow Birth means listening to the wisdom of the body, and letting the body take its own time.  In Slow Birth, the clocks are all turned around. If we rush the body, we often do it harm. Slow Birth is like lovemaking...it just doesn't like to be rushed...and interference can stop it completely. 

Slow Birth doesn't mean that the birth has to take a long time.  Birth should stand outside of time.  It may be fast.  It may be slow.  But birth should be allowed to take the time it needs.

Slow Birth - reclaiming the natural rhythm of pregnancy, birth, and parenting. Watch for the launch of slowbirth.com....coming soon...but slowly...

And in the meantime, take some time to check out my debut blog on SlowPlanet! 

- Jacquie Munro, Vancouver Doula...and SlowBirth...and SlowPlanet

"It's a GIRL!!!"

That exclamation is becoming more and more rare. I miss hearing it at every birth, now that so many docs have in-office ultrasounds and clients bring their families to pay-per-view 3-D and 4-D ultrasound "Discover the Sex" parties. These days, the baby's birth is often pretty quiet...no exclamations of "It's a BOY! or It's a GIRL!" any more.

For me, waiting until the baby is born to discover the baby's sex is one surprise that I truly enjoy. It's the best surprise in the world - more people should try it!

At the most recent birth - what a rush - we were ALL convinced that it would be a boy. But the parents hadn't wanted to find out the sex in advance. After two boys, I don't think mum, dad, doc, or doula couldn't even entertain the thought of this baby being a girl. There would have been too much expectation. They just believed they were having another boy, and that was that...

So, when baby came flying into the world after a whirlwind labour (yes, mum was chattering with us about boy names only half an hour earlier, and we were only in the birthing room for, what? nine, ten minutes? before the birth). I really did a double-take when I checked between baby's legs. "No penis...where's the penis?" said my mind. Dad had already seen that it was a girl, and whispered it into mum's ear.

"I can't believe it!" she cried. She laughed. "I'm in shock!"

No longer can she see herself as the "mother of boys". No longer can she call, "Boys!!!" when dinner's ready. Her own perception of herself changed with the realization that she had carried a girl for 9 months. In a moment, this new member of the family had changed the future.

We all looked in awe at this pink, bonnie girl, who tipped the scale at over 8.5lbs...and has a bottom lip that is already familiar with a pout that you can ride a bike on!

Yes, for sure..."It's a girl!" What a wonderful surprise!

(2/12/09 -  Tee! Hee!  She bought a PINK hug-a-bub for her baby girl, Paloma. So cool!)

- Jacquie Munro, Vancouver Doula

The Birth Paradox

On my first day of Stats 316, my prof said that there was a 99% probability of finding two people who shared the same birthday in our class of 57 people. This is known as the "Birthday Paradox". Well, I think I was hit with the doula equivalent today.

I walked to my visit this morning. As I got closer to the couple's house, I thought, "This is really close to where Julie and Trevor lived then they had their baby in 2001." I walked another block, checked the address...and, it was EXACTLY where J&T lived. The same green house on the corner. I know the bathroom where she laboured...the stairs she walked down as she headed to the hospital. Wow! I know this home has good birthing energy.

Funny thing is...I am working with ANOTHER couple right now who ALSO live in the same house as former clients. And neither of these couples have ANY connection to the former clients who used to live in their houses. No connection...

So...that's TWO repeat houses at once...after 21 years as a doula...after 800 births. Is it some sort of record? Or does it say something about the folding of time, the paradox of time? Or does Jacquie energy remain in these houses?

Let's call it the Birth Paradox.

- Jacquie Munro, Vancouver Doula

Gentle Birth, Gentle Mothering

I've just ripped open my delivery of new books. I love new books. Shiny, unmarked. I have this crazy habit of wanting to keep the books that way, so I never crack a spine. The only book that is messy and crazy bent is my old edition of "Your Baby and Child" from 1983 that is now in the safe-keeping of my daughter.

So, with the packing dumped on the floor, I curled into my big chair to look at Sarah Buckley's book "Gentle Birth, Gentle Mothering". I've been wanting to read this book for a long time. As a lurker on the Maternity Care Discussion Group (MCDG/Matrix) email list, I read Dr. Sarah's posts from Australia and know that I'm going to love whatever she's written. She gets birth. She just gets it.

So, I started laughing when I read the blurb on the back of the book...she writes about "undisturbed birth", the need to surrender, the need to turn off the clocks... Hey, that's what I say to my clients! Those are my words! I've been using these words for over 20 years!

But none of this is ours...it all belongs to birth. Birth, if we listen closely, tells us the truth about us, our bodies, and our minds. Sarah's words are my words because we both listen to birth.

I think I'm going to enjoy this book...

Later...(2/1/09)...I'm still reading Gentle Birth, Gentle Mothering by Sarah Buckley, but I think I'm going to have to make this required reading for clients (with Ina May Gaskin's Guide to Childbirth). Sarah discusses everything that I've been telling my clients for years, but she includes the updated research citations to back it all up. Read the "Undisturbed Birth" section, and you won't look at birth quite the same ever again. It is quite compelling...
Much later...(2/6/09)...I was sad to finish this amazing book, and handed it off to my daughter, Sarah, for her appraisal. I'm getting phone updates: "The gestational diabetes section is great - a bit overwhelming, but her conclusion is priceless." I'll get it back from her and start reading it again...

- Jacquie Munro, Vancouver Doula

Two baby girls in 24 hours

Well...it was a busy day. LL's water broke late Monday night (first baby), but there were no contractions immediately. She said that she'd try to sleep and call me in the morning. Only a few hours later, the phone rang. I answered, thinking that the contractions must have started quickly...but it was LF in labour with her third baby. I knew she was going to be quick, so I crossed my fingers and headed off to meet them at the hospital.

This is always a dance for a doula...two clients at once. I knew I had backup at the ready, but I felt pretty sure that I'd be able to make it to both. I just had a feeling... I decided not to panic.

At about 5am, I was at the hospital with LF. She was at the "I really don't like this any more" point, and feeling more "pushy", and I knew that the baby would be born around breakfast time. My phone rang...it was LL's husband. They'd started contractions at about 3:30am but had held out, wanting me to get a good sleep. Ah...but I was already up and deep into another labour. I reassured them that my backup (daughter Sarah) would be there as my mini-me within 20 minutes, and that I would follow, probably around 9am.

Well, it miraculously worked out just like that. LF's baby came in pretty much one smooth push...amazing...beautiful. The staff were attentive and trusted her through and through (not even a vaginal exam to confirm full dilation - just a trust in the mum's own body wisdom) and the baby came so sweetly.

Not long afterwards, I heard from Sarah, "We're heading to the hospital" (not the same hospital that I was at...of course). I hugged the new mum who was still glowing (can I tell everyone that you're an amazing 50 years young, LF?) and headed through the slippery snow to LL. I found her in her apartment lobby, hugged my daughter, and followed LL and her husband to the hospital.

After a quick assessment, we headed back to their home for extended shower time, then returned to the hospital hours later...and thankfully qualified for a beautiful room (5+cm dilated will get you the "Hilton").

Now, earlier in the morning, LL had told Sarah that she had a feeling that the baby's hand was up near the head. Well...12 hours later...after hours and hours of powerful pushing (we really pulled out all our tricks) we saw that baby...right arm crossing her chest and her hand up by her left ear. LL had managed to push out that baby, despite one of the more challenging compound presentations ever. She DID IT!

Two triumphant mums. Two beautiful girls. One thrilled doula...who tumbled into bed exactly 24 hours after she woke up. What a fabulous day!

Thanks to all the amazing staff who went above and beyond to help these two mums have the best experiences ever. And to the amazing doc who helped us squeak out the "let's think outside the box" baby...you are truly gifted. Thank you for trusting birth - completely.

- Jacquie Munro, Vancouver Doula

Myth #783 - Birth is Scary

After she had her baby the other day, this new mum said, "You know, once you're in it, labour isn't scary! You just do it!"

I have so many clients who have carried the fear of childbirth with them for years and years. Some even postpone the event for as long as possible, just because their friends (or families) have told such horror stories over the years.

I tell my clients that our bodies aren't going to spring something TOTALLY NEW on us when we're in labour. Birth is something you know! Contrary to popular belief, labour really feels like period cramps, low down, way down there, NOT all over your body. And it comes and goes (unlike period cramps which are continuous and can last for days). Yes, it gets very strong, but, as long as the birth is normal and you have continuous support, it is totally do-able (not totally fun). (Remember, the World Health Organization believe that 10% of birth should be cesareans, no more. That means that 90% of births should be "do-able".)

Surprisingly, labour can be frustrating, even BORING, at the beginning. Your body hasn't taken pity on you and started the endorphin surge yet (ah, when it comes, SO good). Until those endorphins kick in, you're fully present, fully raw, feeling and thinking and using your left brain (nasty left brain). You start to think, "If it's like this now, I'll never be able to take it when it's 10 times worse." It shouldn't be scary if your doula is talking you through this part on the phone, or popping over to your house, if necessary. But, hang on, if birth is undisturbed (that's the key!), then it never gives you more than you can bear. Active labour begins, your endorphins kick in, and your body goes into auto-pilot...no thinking...you just "do". And you can do it!

Your friends probably found labour scary because they didn't have the assistance of a doula or midwife, didn't have an undisturbed birth, didn't work through their fears in advance...nine out of ten times you'll find that the couple were on their own, left to stumble through it alone. Now that's scary!

So, the other day, we headed to the hospital when her contractions were close together and very strong. Bloody show - check. Feeling pressure - check. Contractions palpate as strong - check! She was at the "frickety! frickety!" stage (as one mum described it). She loved standing by the sink, both at home, then at the hospital. We got through the passing request for an epidural (always happens at 5cm) and out the other side (I was thankfully backed up by our amazing nurse). As her labour progressed and the endorphins kicked in (big time!), her face became smoother, she began to sway her hips, she became calm and quiet. The lights were low. It was beautiful to watch her labour progress undisturbed. I knew everything would be fine.

This is a woman who had thought that labour would be very scary. But, with support, she found that this was something that she'd done so many different times over her lifetime - labour was a challenge which she could meet. She had the mental fortitude, life experience, and the tools at hand. Birth was something she knew. I don't think she'll be scared about anything again.

Crashing through our fears and our cultural myths is what's scary - Birth isn't.

- Jacquie Munro, Vancouver Doula

The Girls!

Man, I do love working with clients for a second (or third or fourth) time!

I get to really connect with the mums, dig deeper into what makes them (and their labours) "tick", and watch the emergence and transformation of a mother.

I love the postpartum visit, where I always manage to have a tea-party (or, in this case be presented with a wooden mixer and a plate of wooden toast, wooden egg, and a special spoon) laid on by a little sparkling one in a tutu, play a song or two, and hold a crying baby.

It's a wild and wonderful visit with lots of laughter, and tears so close to the surface that you can almost touch them.

I love to see these mums finally understand that their first (typically LONG) labours were just normal for them (and their baby) on that day (no one's fault, no guilt, it was what it was)...and that their second labours were glorious life-affirming gifts. What healing! What depth of understanding comes at this time!

No wonder we're all smiling (all except that wee one!)

- Jacquie Munro - Vancouver Doula

And Charlie makes it 800!

Welcome to Charlie, the bonnie lad who has the honour of being my "800th baby"!

His mum was amazing, surprising even herself with her stamina, strength, and power!

His dad surprised himself at being able to stay in the room!

No interventions, no nothing, what a thrill!

- Jacquie Munro, Vancouver Doula

Van"cool"ver?

I was driving home from visiting clients yesterday, and the CBC radio host was talking to a guest, asking if she lived in Van"cool"ver. It made me laugh, but it also made me think about one of my clients had been talking about her experiences at a Mum's Postpartum Drop-in. The women she had described sounded just a little bit to "cool" for a brand new mum to embrace.

I mean...imagine you're a brand new mum...you've made the first trek out after being trapped in your house by the snow for WEEKS. You've been looking forward to this first drop-in mum's group - "Maybe I'll meet some new friends...and we can go out for coffee...our kids can have fun..." You get your baby tucked into her stroller. You dream about how great it could be as you sweat and grunt and push that stroller through the snow and ice.

Then you arrive, feeling pretty good about yourself. It's the first day of the new class... You look around, still unwrapping your scarf from around your face - and you realize that everyone there looks like they know each other. You realize that you're the "new kid".

Inside jokes are flying back and forth. One mum suggests to the group that they all trek over to the North Shore to take in a "Mum and Babe Snowshoe Trip". "They even have a breastfeeding tent!" Another mum turns and asks if you know any new spelt recipes...

Van"cool"ver is right. And now you've lost all the happy expectant energy that you had...

Now, I know that there's a point in the life of a new mum where things have finally fallen into place, and you can happily head over to Cypress and strap on those snowshoes. That's fantastic! But should you (with your seven month old) be in a newborn drop-in class still? Or, if your talk about snowshoeing is masking your inability to cope, and you still really need the support, could you please spend some time including the new mums in your conversation? Those new mums would really appreciate it.

I have to thank my best friend of 25 years for being that stranger, that veteran mum (her daughter was a whole 5 weeks older than mine), who welcomed me with open arms at my first drop-in. She had just watched my daughter throw up ALL over me (I mean, drenched!), and saw the look on my face. She came right over and said, "Would you like to come over to my place for tea and muffins afterwards?" Her invitation made me smile, so I just grabbed a receiving blanket, and mopped up the mess without a bother.

My mum's group got me through many months of struggle. We started out as a diverse bunch of strangers, and then became friends. The veteran mums told me to turn on the fan over the stove - great white noise to help the baby sleep. They helped me negotiate the emotions of those first few months. They'd come over to my house, and we'd sit on the kitchen floor, watch our babies learn to roll over each other, and burst into tears at random points - but it would be okay....better than okay...it would be wonderful. We graduated from the mum's group when it was the right time to go, and organized our own group play-dates for another few years.

So, to the new mums who didn't take notice of that new mum in the corner, didn't notice that she'd been really courageous that day, didn't notice her personal feeling of triumph after making it through the snow to her first mum's group...please say "Hi" to her next time - she's quite amazing! I was her doula, and she was powerful in labour, and is a wonderful mum. She's just not ready for baby snowshoeing or spelt...yet.

Haiku

The birth cry
between my thighs/
stretches into budding tree darkness

Mikajo Yagi (1924-)

On Keeping Tidy

Myth #3297:
"You shouldn't have a home birth because it's too messy!"

One client's mother, a surgeon, was concerned about her daughter's decision to have a home birth because, "I walk around the OR with my boots covered in blood, dear. It would be SUCH a mess!" I asked her if we walk around our houses during our periods with our boots covered in blood. "Well, no," she answered. "That's silly. We wear pads or tampons." After her daughter's home birth, the surgeon Grandma was amazed..."I guess it's the docs that cause the mess!"

Well...labour at home (even when planning a hospital birth) is clean because we are used to keeping clean when we bleed on a monthly basis. Labour is no different. And, for some reason, women seem to lose WAY less blood at home births - a matter of fully functioning hormones, perhaps?

I think of all the clean and tidy home births that I've attended over the years, and compare them to the memories of some messy (read "gory") hospital births that I've seen. Women just don't realize how fun it can be for the doula and midwives to keep a house tidy during a home birth. All the supplies are laid out on a table (basically, like a modern Mary Poppins, the midwives open their bags and bring the hospital to your home) and two large bags (one for garbage, one for laundry - see photo) are at the ready. The woman in labour wears pads, uses the shower or bath to stay clean, and we make sure the bed is double-dressed with good sheets (for a glorious postpartum - see photo) under waterproofing. Within an hour of the birth, the bedroom looks like it does in the second picture.

I make sure that, by the time the woman has finished her post-birth shower, I've provided the "turn-down service," any dirty dishes (from the post-birth lasagna) are in the dishwasher, and any dirty towels or clothes are in the washer. The joyful swish-swish of the dishwasher, and the thrum of the dryer even sound clean. Family members can come for a visit and not believe that a birth took place right in the middle of the living room!

Hospitals can afford to let the birthing rooms get very messy - someone else is going to clean up (though I do try to make sure that things are tidy throughout - I'm a neatnick!) Floors can be sanitized, and sheets are just thrown into the hamper for industrial cleaning. No one gets into trouble for tracking blood/fluids all over, and the placenta just hangs out in a bowl on a table (not fun for visitors!) (Notice that I'm not going to start a discussion about the possibility of infection at the hospital.)

I've attended some rather impromptu home births over the years (a speedy labour with no way to get to the hospital in time), and have managed to keep things together with just one Canadian Tire waterproof blanket (right, Laurel?) Chuck the blanket away and the cleaning is all done!
And, no...you don't have to clean up after yourself! Just one client tried that. We caught her on hands and knees, half an hour after birth, cleaning the tiles in the bathroom, "so the dog won't know I had my baby in here!" She was just supposed to be going to the toilet!!!

So, let your decision to have a home or hospital birth be based on information that matters. Where would you feel the safest? Just do your homework, then know that, if your baby is born at home, all will be tidy, and your bed will await. You will just have to walk to your bed, and climb in - it might even have a chocolate on the pillow!

Rituals

When my daughter and her husband were married, a strand of beads was held in their hands. From a crystal bead that came from Great-great Grandmother Sarah's necklace to a stone from their favourite beach, each token holds a message from those who will support them in their marriage.

Just like birthing beads in Africa, where each woman attended by a midwife adds a bead to the midwife's strand, increasing its power and significance, this strand of beads gains its power from the wishes and love of each person who contributed a bead.

I have always loved ritual. As a child, I was more in love with the ritual of the Anglican church service than the Christian faith itself. I loved the music, the chanting, the link with history. When the church dropped the Book of Common Prayer and the use of Latin in daily service, I was ready to leave. I had to be content with the occasional trip to Europe, where, slipping into a Catholic Mass in Rouen, I could feel at home and recite the Latin words without thinking. In labour, I sang the Gloria without even realizing what I was singing. The ritual of recitation (not the faith) brought me strength.

In labour, these remembered rituals can be so potent. I often hear women in labour singing old hymns or songs or nursery rhymes in the shower. Women often revert to their mother tongue in labour, even if they've been speaking English for years. A Ukranian nurse shouting in the hallway has the power to make a woman from Kiev smile and relax. Sometimes, hair brushing, just like a mother will do for a child, will be the link to the past that calms a woman in labour.

At a cesarean birth long ago, Tibetan monks brought in a fuschia-coloured silk scarf, or kata, that had been blessed by the Dalai Lama. That was the first piece of cloth to touch the baby after birth. The OR was transformed by this ritual. The walls seemed to fall away...the surgical steel disappeared. All that seemed to remain was the baby, shining in the light.

Birthing beads, a mala, a blessed kata, a song, a whisper in the ear...these rituals mark our important life events. I wonder what rituals my own children will use to mark the birth of their own children...what rituals I will witness at the births of my clients this year... I wonder.

Summertime...and the living is easy...

It's still snowing outside, so I'm just going to think ahead to the summer. I'm really sad (but, oh, so happy) to say that we'll be away in Scotland, England, and France from August 3rd until September 8th.

Returning clients have already started to call for the month of August, and I've had to break the news gently. I do hope that any other returning clients who are due in August will still call and use me as a resource (I'm always here for you to call!) But, you may want to consider working with my favourite midwives for this pregnancy! You'll be in amazing hands.

- Jacquie Munro, Vancouver Doula

Birth with Two Snowmen

Birth is never what we expect. Even though we may say we don't have expectations...we do.

So, when I arrive at the hospital around 6am with a client who is 7cm and stretchy to full dilation...there's a part of me that expects her to be happy and nursing her baby by lunchtime. Admit it, Jacquie...after almost 800 births as a doula...you do have certain expectations.

Yes, I must admit, I do have some expectations. But, so do you. If someone told you the birth story later..."she had her beautiful baby girl at dinner time"...you might say, "I expect that she had an epidural (isn't that something that usually slows the labour?)" But, no, she had no epidural, no pain meds at all. Things just slowed down to 1 or 2 contractions every ten minutes for most of the day. She even managed to sleep.

What made things slow down? Probably not just one thing. Perhaps it was a combination of our collective expectation (totally subconscious), head position (asynclitic/deflexed), and/or compound presentation (hand or cord in the way?) Or maybe it was, as some cultures believe, the will of the baby. She might have just wanted to be born at dinner time..."I don't like breakfast!"

So, though I'm sure we all had the expectation of a quick and uncomplicated birth, that just wasn't this mum and dad and baby's story. This birth was our reminder to respect the need for infinite patience, and to respect each baby's journey, each family's journey together.

How else would we all have had such a special day to watch the snow quietly, honour the passage of time, and see their family gather, build two snowmen, and shed great tears of joy when the baby finally arrived. I don't think the day would have been quite so wonderful otherwise.

- Jacquie Munro, Vancouver Doula

The Recovery Effect

It's really odd. Whenever I'm recovering from an illness, all the births come easily and quickly. So, what's with that? In the first couple of weeks after I returned to work after my Uterine Fibroid Embolization, I laughingly said to clients that I could only manage a 6-hour labour. It was a joke! But, they all obliged.

No, I don't really think it's a fluke, because it's happened before. When I was recovering from pneumonia one year, all births in the recovery month were speedy, and I seemed to spend less than 6 hours with each. No kidding! (And, no, it wasn't that I showed up late and left early.)

It seems to be the same effect that occurs on a day when there's a nursing shortage(due to fabulous weather?) at the hospital. If I'm told by the assessment nurse that there are only beds for women who arrive "ready to push", then my client miraculously speeds to full dilation in no time at all.

The mind is a powerful and wonderful thing...

My only worry is...now that I'm totally well and feeling great...will my clients have long births again?

Hmmm...a dilemma...

Anyway, here's a snapshot of the births that I've attended recently...

Eli - Ah, the beautiful boy who wanted to get here extra early. "What? They want to send you to Prince George to have the baby? I'll fix this!" And we fixed it. Phew! Now THAT was a whirwind birth...17 minutes from "I think the baby's coming", was it?

Eva - How can I be even more emphatic in future when I tell clients to get in the car (during what they think is early labour) and head to the hospital? "Yes, I know your first birth was long...but you had forceps! There's a wide open freeway available for this baby, and she's going to use it!" We met at 69th and Oak...and panted and breathed all the way to the hospital. I'm so happy that we have cell phones to alert the doctors and nurses that we're INCOMING! "We did it!" cries mum.

Noah - Another second baby who followed the "slow slow easy...BOOM!" entry to the world, thanks to a doctor who knows how to spin babies. I love these posterior babies with strong personalities. They certainly know how to make a grand entrance when they decide to come (4-10cm in 20 minutes)!

Ella - A first baby who wanted to pretend that she was a second baby... Ella made her mum dance and sway, then make a dash to the backseat of my car (funny memory of the concierge trying to focus on reading his paper while she laboured in the lobby). Zip up to Cedar at BC Women's...and voila! Ella came so quickly that it surprised pretty much everyone. The sun shone through the skylight...amazing.

Lauren - Wow...another first baby who wanted to earn the speed record (4-10cm in less than 2 hours, when you'd expect 6 hours). I just love mum's words as she started to push..."It wasn't that bad." ...and dad noticing that the baby sounded like a "baby pterodactyl". Just wonderful!

Oscar - He came so quickly for a first baby...unexpectedly born in the hospital, but home before bedtime. His mum laboured with grace, and his dad touched his head, a sacred act, just minutes before he was born. Sweet pea!

Amaan - A dark night...driving through the rainy streets...a long walk up a hill to the hospital entrance (stop, hug, pant, breathe)...then gentle care as the baby comes quickly. "I did it! I felt it all!" Welcome little one.
What a triumph!

What a joy and a gift to be able to be a witness these miracles.

- Jacquie Munro, Vancouver Doula

Good as New

Touch wood...I'm feeling as good as new and ready to work!

I'm not allowed to lift anything (like a post-cesarean mum) for a while yet...but I generally don't plan on lifting pregnant mums. That's a job for the dad!

So, please don't hesitate to call me!

"Oh, is this the fibroid?"

Well, well...take a look at the quote above. Picture the scene. Lovely, caring and chatty admitting clerk walks me up to the ward (with my dear husband). Since it's 6:30am, there are no nurses to be found. A nurse comes out of a room and wanders down the hall (was she sleeping in there, I wonder?)

The clerk says, "I have a new patient for you," and the nurse replies, without looking at me..."Oh, is this the fibroid?"

The clerk pointedly answers, "Her name is Jacqueline Munro, and she's here to have an embolization this morning."

Rather than making me upset, this dehumanizing language almost almost made me snort with laughter. Three thoughts instantly came to mind: 1. Sarah Palin (queen of the stupid comment). 2. If only I was a cartoonist, then I could have done this comment justice. 3. Who teaches these young nurses anyway? Empowering and respectful language is paramount, girls!

Thankfully, shift change comes quickly, and my pregnant (of course!) day nurse K was lovely!

Thoughts and questions about my hospital experience...

1. Everyone should have a doula...for anything done in hospital. At least the doula would make everyone introduce themselves!
2. Catheters without an epidural are not fun...not exactly painful...but very unpleasant.
3. Why are patients blamed for the nurse's inability to successfully insert an IV on the first try? "You mustn't have been drinking enough water." (Nope...I'm floating in the stuff!)
4. Nice art work in the recovery area at UBC...very nice... (Okay...I must be drugged) The Fellow says I have more fibroids than she could count (I love being unique).
5. Why did the anesthetist play Bob Dylan's Blowing in the Wind? And why do the nurses and resident think that it's Willie Nelson (They're TOO TOO young to be working on my body!)
6. Why did everyone start talking about Halloween while I was being given a cocktail of conscious sedation drugs?
7. I want to thank the porter for singing me lullabies while in the elevator.
8. I'm not accustomed to having a heartrate of 44 (Is this the effect of fentanyl or morphine? Yikes!) The talk of atropine doesn't thrill me.
9. The bed was quite comfy.
10. Wherever I go...even when I'm totally drugged...people tell me their birth stories in great detail, and want to know if I approve of their doctor/midwife/OB/hospital choice. I just want to sleep!
11. Who added those sickening bumps to 16th Avenue?
12. Why don't I remember seeing the specialist whose name is on all my prescriptions? Was he hiding or did the fentanyl make me forget?

One client said she's happy that I'm going through all this...at least I'll have the hospital experience fresh in my mind. Well, I can tell you that I can now relate to having narcotics (I stopped taking them asap), that I understand the agony of post-surgical gas pains and nausea (someone needs to warn you about this BEFORE the cesarean), that I know the feeling of a digestive system that isn't quite ready to start working again (also - thoroughly unpleasant), and that I now feel like I'm 10 weeks pregnant (and waiting for the morning sickness to go away).

But, I can also say I'm in awe of the fact that my hemorrhaging stopped as soon as I was in recovery. I'm happy about that...but still waiting for the other shoe to drop.

Each day, a little bit better. Those healthy wishes from friends, family, clients and blog readers really do help. Thanks!

p.s. The photo is of a fibroid knitted by a medical student...

- Jacquie Munro, Vancouver Doula

I'm off to see the wizard...

I'm off to see the uterine fibroid wizard at UBC Hospital first thing in the morning. "No food after midnight, etc., etc." This is all new territory for me. My only previous major hospital stays have been for my children's births. Though I'm going in for a different reason, the focus is still on the same body part...the uterus. Everything I do seems to revolve around this amazing muscle. I hope it cooperates tomorrow. I should be up and running in a few weeks...

Wish me luck!

Lady in Waiting

If you’re having a hospital birth, perhaps one of the most challenging parts of labour is the transition from your home to the hospital. Many couples worry about the car ride to the hospital, but it’s amazing to see how most women manage the ride with surprising grace. If the car ride is timed so that it coincides with the trance induced by high levels of endorphins (well past the mid-point of labour), then the whole journey can be manageable.

To illustrate - I vividly remember one client’s ride to BC Women’s from UBC. It was around 4am. She threw a coat over her naked body, somehow managed to run to her car down a long apartment hallway (between contractions), then crawl onto the back seat of her minivan, exposing her bottom to an old man in a trilby hat, who was coincidently walking his little Scotty dog past us at that moment (you should have seen his face!) Bouncing along in the car, this normally private woman laughed and laughed. “That was FUN!” Yes, the trip was uncomfortable, with her husband trying to negotiate hundreds of potholes, but the absurd nature of the trip far outweighed the pain it may have caused.

The stories that result from the car ride can be epic, from the woman riding to the hospital with her head popping out of the sunroof of a Mini, to a recent dad’s call to BCAA: “I locked the keys in my car with the engine running at the Emergency entrance to the hospital!” If you’re lucky, you’ll notice the absurdity in the moment, and laugh.

Now, it’s the hospital assessment room that can be a possible source of stress. If you’re lucky enough to have a midwife who has already completed the assessment at home prior to hospital arrival (which happened last week with one client), you might manage to bypass the assessment room altogether - yahoo! - and go straight to your birthing room. This causes a lot of excitement and very little stress.

The next possibility is that the family doctor will meet you at the front door and do the assessment personally. The continuity of care provided in this scenario is wonderful, and the time spent in the assessment room can be relatively short, provided the hospital can quickly assign you a nurse. There’s also the added bonus of having an additional advocate present to help negotiate the hospital protocols. If I’m lucky, I can coordinate this...but it’s really hit and miss.

If the family doctor is busy with another birth, or en-route, or your primary caregiver is an obstetrician or resident, then we have to hope that the assessment room is not too busy, that all the other women in the assessment room don’t require high levels of care, that the staffing levels aren’t low on this day, and that there’s more than one nurse available to care for the 5 beds in this area. Fingers crossed that the assessment room stay won’t drag into multiple hours, which can easily happen. (I always try to call first, so at least I can alert my clients to the possible delay.)

There are a lot of variables that can increase a woman’s stay in the assessment room. The assessment room nurses (who are amazing, highly qualified, and caring people) do everything in their power to take into account BOTH the triage process and each labouring woman’s needs. There’s a lot of paperwork to be done, protocols to follow, personalities to placate... The assessment room nurse needs 8 arms, two heads, and more than a little wit and understanding, to make it through each shift.

It may appear to clients (husbands especially, since the labouring woman is generally just focused on each contraction) that the nurses are sitting at the desk doing nothing. Often, the people sitting at the nurses desk are not the assessment room nurses, but interns, residents, other doctors, or even a clerk. The supervising nurse in assessment must juggle all her patients to ensure that the woman with the highest care needs can proceed to the next “level”. Granted, the nurse might not be able to explain what she is doing for each woman during the process, but that’s what I try to cover with clients in between contractions. “Yes, it might look like you’re being ignored, but you’re NOT. She’s left the room to negotiate with labour and delivery to have a nurse transfered up to Cedar to be with you, so you don’t have to wait until a Cedar nurse returns from her 45-minute break, etc. etc.” It’s my job to fill in the gaps in information. But, if I need to breathe through the contractions with the woman in labour, the dad will have to wait a bit for my briefing.

Even a 45-minute stay in an assessment bed may seem like an eternity, but it’s about as fast as the system and safety will allow (unless you’re ready to push...then you get to fast forward!) For example, the nurse needs to read a woman’s chart thoroughly to determine her risk status, her drug allergies, her particular needs, and contact her caregiver (and wait for a response). If a nurse is forced to cut corners, a woman could inadvertently be given a contraindicated medication (i.e. fentanyl being given to a woman with an drug allergies), or miss important medical information. I am able to highlight certain important points when I speak personally with the nurse, but she must confirm this by reading through the notes, and then doing a thorough history and assessment herself.

The setting certainly doesn’t make a labouring woman feel safe or calm. The beds are narrow, the space is noisy... But, I ask all clients to imagine that we’re still home, to keep their eyes closed, to focus on a calming hand, the soft pillow, their partner’s voice, my voice. Often I have to talk the woman through each and every contraction, so that she remains calm between each contraction. Yes, she might roar during contractions, but that’s her way of coping. It’s the in-between times that tell us how she’s doing. If she’s able to breathe calmly between contractions, or even say, “Wow! That was intense!” or “I didn’t like THAT one!” then she’s fine. (I try to wangle assessment bed 5...the one with a DOOR!)

As a doula, the assessment room experience is certainly challenging. It takes years of experience to negotiate the process gracefully and diplomatically. Most problems can be prevented creatively. Petty staffing wars can be averted by anticipating them in advance, and steering clear of potentially tense situations (trust me, I’ve seen it happen recently.) Protecting the woman in labour is paramount.

Sounds like it’s better just to stay home until you’re ready to push (which is what one doctor laughingly suggested recently).

Hmmm...at least you have a doula with you who knows the staff and your caregiver, and can provide the best possible “concierge service” around...

- Jacquie Munro, Vancouver Doula

Ticking the "Home" box

A former client recently emailed me, asking me to write a post about home birth. Was she searching for information for the ongoing debate with her husband? Even though it is the woman who must ultimately make the decision about her birth setting, it is imperative that her partner is included in the process of informed choice, and comes to understand and support her decision, without fear.

Since I'm known as the research-oriented and pragmatic doula, I'd better throw in some evidence. So, here are a few things I want you to consider:

1. When you are presented with two equally effective treatments, then "best practice" requires that you take into account the patients' preferences (that means HER).

2. The Province of British Columbia Ministry of Health fully funds care by registered midwives, both at home or hospital.

3. A 1986 World Health Organisation report concluded that “home is the most appropriate birth setting for most childbearing women. Women (and their attendants) choosing this option must be provided with necessary diagnostic, consultative, emergency and other services as required, regardless of place of birth.” See College of Midwives of British Columbia.

4. In 2002, the "Outcomes of planned home births versus planned hospital births after regulation of midwifery in British Columbia" was published in the Canadian Medical Association Journal. The results showed that "women who gave birth at home attended by a midwife had fewer procedures during labour compared with women who gave birth in hospital attended by a physician." "Comparison of home births with hospital births attended by a midwife showed very similar and equally significant differences." The final interpretation of the study was that "there was no increased maternal or neonatal risk associated with planned home birth under the care of a regulated midwife."

5. In September 2007, the UK National Institute for Health and Clinical Excellence issued clinical guidelines (The NICE Intrapartum Care Guidelines) on intrapartum care of healthy women and their babies during childbirth. Under ‘‘key priorities’’ it stated: ‘‘Women should be offered the choice of planning birth at home.’’ Information suggests that for ‘‘women who plan to give birth at home or in a midwife-led unit there is a higher likelihood of a normal birth, with less intervention’’.

After attending almost 800 births in my 21 years as a doula, I can now say that I'm most comfortable (and I feel most safe, actually) at a home birth, with a client who has come to this decision freely, who is autonomous, who is radiantly healthy, whose midwives (there are always two present) are trusted and respected by all of us, and who has a partner who fully supports her decision without fear. But that's me...now.

I can't squish a woman into that mold. I would never want or expect everyone to be "that woman". A woman must go on her own unique and challenging journey to trust birth that much. I trust each woman to make the decision regarding the best place FOR HER to give birth, and with whom to give birth. I support each woman without reservation, no matter what her choice. In order to give birth at home, a woman has to gradually grow into the person who can make that decision. I know I didn't reached the point where I would have chosen home birth until I was 31, after giving birth to two children, and after attending over 100 births (many at home). Until then, I simply didn't have enough information to make an informed choice about home birth myself, even though I HAD made the amazing, and life-changing, leap to midwifery care for my second birth!

So, to the couples who are spending evenings debating home birth (she wants it...he's not sure...grandma says "over my dead body"), please do your homework. The research is clear. The more difficult task is to deal with the images swirling in your heads - images born of myth, misinformation, and fear, fueled by society's expectations and the media's lopsided representation of birth. You need to talk to people (call me - my clients would love to share!) about their personal experiences of home birth, watch movies which include home births (like The Business of Being Born or Le Premier Cri), and understand that choosing home birth doesn't lock you into that option. It just means that you can now include another option in your choice of birth places - you can now tick the "home" box.

When asked where she was planning to have her baby, one family doctor with four children would always say, "Wherever it wants to come out!" (In the end, she had #1, #3 and #4 at home, and #2 at the hospital) Because...on the big day, if you've given the body and the baby both options (hospital AND home), their final choice is always loud and clear!

Now, if I could only let you into my head to see the images of the home births that I've attended...but that's for the next post...

- Jacquie Munro, Vancouver Doula

Lying in...

Well, this month has continued to be full of lessons for me. I've been listening to my body and caring for it very well. I'm astonished at how much better I feel already. Though still anemic, I'm light years ahead of where I was in August. I can climb stairs and not pass out! My heart isn't racing if I walk to the bathroom! I realize now that I was living in a perpetual state of "pseudo-9-month-pregnant life"...you know, that period where you deliberate over moving the bed into the living room just so that you won't have to climb the stairs...or find that linking arms and sauntering is de rigeur (rather than your usual non-pregnant power walking).

I'm well enough to feel good about heading into hospital on October 8th. I'm not daunted by the post-procedure pain that I've been warned about ("You should be able to relate...it's like a couple of days of labour," said one doctor.) I'm not going to fight the suggested recovery time of a few weeks... I will listen to my body and honour its needs.

(p.s. The amazing painting is "Crawl Out" by Vancouver artist Madeleine Wood)

- Jacquie Munro, Vancouver Doula

Listening to your body

Well, it's certainly been an interesting month...I now know how the VGH ER works when you really need it (yes, the triage system works well and I jumped to the front of the line!), how little an IV hurts when you REALLY need it, and how fast you can get appointment with specialists in the BC Medical system when you are considered URGENT. I also know the odd, prickly, clammy, scary feeling that comes from losing too much blood...very interesting (from a professional standpoint), but I don't need to experience it again.

The whole time, my mind stayed in doula mode..."Ah, that's what a good fast IV feels like"..."Interesting - even though you know there's no needle in there, you just don't feel like waving that IV arm around". I was happy to receive such respectful care from the VGH staff (who even turned around my bed to face the wall so I could gain more privacy during an exam, without me asking). And, in the middle of caring for me, one nurse chattering, "Wow! You attend births? I think cesareans should be the way of the future...I'd rather crack open a chest than watch a birth. You're so brave!" I laughed, even though I felt ready to pass out.

And I can still see the smiling face of the ER doctor as he came in and said, "I want you to know that the biopsy was negative for cancer." I almost laughed...I really (amazingly) hadn't considered that to be even a possibility. It was quite funny, honestly.

Interestingly...I presented with such CRAZY high blood pressure (I've NEVER even seen a client with HELLP syndrome have this high BP) that I got 3 nurses at once. Hmmm...probably not something to brag about. So...I'm not pleased with my body this month, and that's an odd thing for me.

I always tell clients that they can trust their body, that we just have to figure out what the body is trying to say. Well, I'm listening and waiting...

Perhaps everyone's right in saying, "Look, you have cared for others for 20 plus years. Now it's time for us to look after you."

So, thanks so much to my docs, Stephanie and Kristin, for telling me to take this month off, and expediting matters so successfully. Thanks to my clients who call to check in, or send text messages that make me laugh. Thanks to my husband (for taking time off work to care for me) and my family (my mum and dad even come and clean for me!)

And that postpartum tip about asking for help? It works! If you just tell people how you really are doing...they will step in and help. It's quite amazing. The struggle for new mums (and now me) is in the acceptance. I think I'm good at acceptance now.

So, to all my current clients due in the next few months...we'll just have to see how my appointment goes next week, and then I'll be giving you a call (surgery may await!) My daughter, Sarah, and I might be doing tag-team birthing for a while. But, I'm always here, ready to listen and help guide you through your pregnancy (this hasn't affected my mouth or ears!)

Okay, body...I'm listening...

The curse of the efficient woman

I always encourage clients to send me a blog post after their birth. Here's a post that I asked dear Kate to write after she told me about one day in her "life as a new mum". I'll be writing more about her amazing home birth (and the string of amazing home births I've attended) recently....as soon as I've had some sleep...

"This is for all the women who are doing very well... you know the kind - maybe you are one. One whose families are wondering, why does she keep calling her doula every two days? Surely a doula is just necessary for the labour part. Maybe even your husband, who was over the moon at having a doula present at birth, is a little skeptical:

"You like calling Jacquie, don't you?"
"I do! And she says we can call as much as we like anyway!"
"I guess she hopes that it tapers off after awhile, even though she says she's ours forever."
"Well she doesn't expect it to taper off THIS quickly!"

My father's partner calls this "the curse of the efficient woman".

I admit it, I'm doing well. My labour was short (so short, we didn't make it to the hospital - hurray for homebirths!), my stitches have healed, my breasts don't hurt, and we get some sleep every night. My baby is gaining weight and generally seems happy. Now he is five weeks old, and I made it out to stroller fit yesterday. Today,with Sacha happily sleeping in his baby wrap, I cleaned the garlic we've grown in our garden and made a fresh batch of granola, all before noon - perhaps I am an efficient woman. But even we have 24 hour periods like the one I'm going to tell you about, when Sacha was just 3 weeks old...

Nana, my mother-in-law, was visiting, and we decided to head out to Langley to pick up some berries. While we were there, I figured I ought to have lunch with my baby sister, still just 19, who lives there with her mother (who is not my mother). Anyhow, my sister has a stepsister, also 19, who had a baby 4 days after mine. I have worked hard to avoid jealousy over the fact that my own baby sister has another nephew to adore just when I have provided one for her... So when, during lunch, my sister holds Sacha the entire time, but talks steadily the ENTIRE time about the OTHER baby, I do my best to smile and encourage. After all, a teenage mum needs support, and I should be glad my sister is helping out so much. When we were sitting in the restaurant after my sister leaves, Nana takes Sacha and says to him, "Well, Baby X sure is a perfect baby, isn't he?". I laugh, relieved that I'm not crazy. And after all, I am doing well... so I still have a sense of humour.

Later the same day, Sacha, Nana and I are on our way home... Unfortunately, we overshoot feeding time by about 15 minutes. The last bit of the drive home is a combination of wild, distraught screaming from Sacha, punctuated by eerie minutes of silence in which I become terrified that he has screamed himself out of air... But, we make it home and he gets fed. I laugh, relieved that I can so easily meet my baby's needs. I am doing well...

Midnight that night, disaster strikes. I have fed Sacha, and burped him. When I lay him down right after a feed, he gets the hiccups, starts to cry, and things go downhill from there. So I am in bed, slighltly propped up, with him on my chest. Have I mentioned my son is strong? Somehow, while I am semi-dozing, he pushes up, rolls to the side...and right off me onto the floor. I jump up with a shriek, pluck my beautiful baby off the hardwood floor, and lay him on the bed to examine... he hasn't even woken up... his eyes open as and he sees me above him, talking hysterically to his father about whether he is concussed, whether we need to take him in to the hospital. Meanwhile, Nana runs into our room having heard the fuss... there I am half naked sobbing "I d-d-d-d-ropped him on the fl-fl-fl-floor..." We all notice that my nursing pillow is on the floor right where he landed.. Everyone concludes that he landed on the pillow. And, well, babies get dropped (I got dropped 3 times on my head according to family lore). I laugh, relieved that Sacha is ok, there are no bumps and bruises. Nana goes back to bed. But I am officially NOT doing well...

"Aren't you mad at me?" I ask my husband, still sobbing.
"Of course not. You didn't mean to, and he's perfectly fine!! "
"But if you'd done it, I'd be FURIOUS!!"

I cry some more over my own double standards... Eventually, my husband suggests that I take the baby downstairs for a cuddle so I can work out all my guilt. I follow his advice, and an hour later I manage to put the baby in the bassinet and throw myself back into bed for a few hours of desperately needed sleep.

The next morning, I am feeling fragile. But having been reassured by my husband, mother, and mother in law that I am still a trustworthy mother, I venture out. With the baby, the dog, and Nana, we walk to the grocery store. We get groceries (stored nicely in the stroller, while baby snuggles in a sling). I have overshot feeding time again, and since I'm not about to subject any of us to a long bout of crying at this point, we stop at an off-leash park. The dog runs after sticks while I feed Sacha. Suddenly, my friendly, bouncy lab-cross who still looks like a puppy at nearly 3 years old, starts barking and running towards somebody across the playing field behind us. I jump up, babe in arms, shirt half off, receiving blankets flying, and see that Nellie is headed toward a mother and daughter across the field. Now, I know my dog is all bark and no bite. But, THEY don't. They see a large, black dog tearing towards them. Unfortunately, the mother seems to have no sense of how to react to a dog, and starts screaming. Not just a yelp - repeated, high pitched, terrified shrieking. The daughter follows suit, and just to add to the effect, they both start running in circles. Nellie thinks this could be a fabulous game, and keeps on charging towards them. They keep shrieking and running in circles. I start to wonder how this is going to end as I'm yelling "SHE'S FRIENDLY, JUST STOP SCREAMING. PLEASE!!!!!!!!! STOP SCREAMING!!!!!!!!!!!". I alternate this with yelling at Nellie to come back. After a few crazy seconds that felt like minutes, Nellie comes prancing back, very proud of her efforts, and the mother and daughter aren't shrieking, but the mother is yelling at me from across the field, accusing me of having a vicious dog off leash (in an off leash park, of course). By this point, I am shaking, the baby is crying, and Nana is trying to pull the pieces together. We put Sacha in the stroller with the groceries, get Nellie on her leash, and make a beeline out of the park (as fast as we can considering Nana has recently finished a course of chemo, and I still have stitches on the mend.) I laugh, glad that Nellie didn't reveal any new aggressive tendencies, but there is more than a little hysteria in my voice. I'm not convinced that I'm doing so well...

We make it home. I go to use the washroom and see that I have acquired a blotchy rash all over my neck and face. Nice touch. Nana suggests that it might be stress related, takes the baby, and sends me for a nap. An hour of solitary sleep and a tearful phone call with my own mother later, and I feel like I could possibly soon be doing well again.

So, for all of you who generally do well, and maybe don't feel like the roller coaster ride of early motherhood is quite as crazy-making for you - don't fall prey to the curse of the efficient woman -- let everyone know that you need just as much TLC, and make those phone calls to your doula!" - Kate, mum of Sacha James (and Nellie the dog)

"Silence is the perfectest herald of joy" - William Shakespeare

I remember going to one of my first doula visits (with the woman who would eventually give up her law practice and become a doula) and talking with the couple about all the things we had to discuss before labour. My client's husband later confided to her that he was alarmed by how much I talked during the visit. "Oh!" I said. "He hasn't seen me at a birth. I'm so quiet. My eyes and hands speak, but not my voice." He was so relieved (I think I'd actually scared him at that visit)...and I went on to attend all three of their children's joyful births.

The reason I talk so much at our prenatal visits, is that there is so much to cover. My own children are in their twenties, and I have been discussing birth with them all their lives. I STILL haven't covered it all with them! Can you imagine trying to filter all the information to fit into two visits (and many phone calls) with clients? It really can't be done.

The best I can do is help my clients get a sense of the underlying philosophy of birth, to encourage them to trust their bodies, to help them to remain undisturbed while going through labour. I still talk and talk before labour begins. But, the volume goes down to a whisper once labour is upon us, just as the lights go down....because we have to be silent to hear the lessons that the coming baby has to share.

- Jacquie Munro, Vancouver Doula

Coming up for air...

Okay, so I've officially decided that the full moon really MUST make babies come in groups!

In the past week there have been so many babies, with their due dates randomly spaced over a six week period. Thankfully, there were no overlaps. Well, there was one 8-minute gap between two clients (it took me 8 minutes to run down the hill from one completed birth at St Paul's hospital to the next client's house on Pacific!)

So, there were two undisturbed home births, two undisturbed hospital births, and two challenging births caused by sweet posterior babies (resulting in one cesarean and one vaginal birth). The largest baby (9lb 13oz) and the smallest baby (6lb 12oz) this week were both born vaginally with no meds. What a ride!

Here are some wonderful quotes from the women in labour:
"I'm not scared, it just hurts."
"Once a contraction's over, you feel like you're in paradise."
"That was good! Almost no pain!" (about contractions in the shower)
"You have no idea how hungry I am right now!" (said at 10cm)
"That was the best experience of my life!"
"When his head came out, there was all this liquid, and it almost healed me..."
"I never knew he'd be this beautiful."
"I never knew she'd be this beautiful."

Now, if everyone else could just keep their legs together for a couple of days... I have my daughter's engagement party to get sorted!

- Jacquie Munro, Vancouver Doula

Baby at the Breast

Sorry...shamelessly proud mum here. My daughter Sarah painted this Warhol-esque breastfeeding baby (acrylic on canvas) as part of her final Breastfeeding Counselor project. Love it!

Now that we're on the topic of breastfeeding... A lot of women mistakenly believe that they will automatically receive incredible breastfeeding support at the hospital and during the initial weeks at home with the baby. Sadly, this is just a myth. Read about the resignations of local lactation consultant extraordinaire Renee Hefti, and then sign up for the breastfeeding courses that she offers in the community (604-733-6359).

Shameless promotion here - but it's truly necessary!

- Jacquie Munro, Vancouver Doula