Archive for the ‘Articles’ Category

What Labour Looks Like – A Movie I Wrote

Amy, the Crunchy Domestic Goddess, wrote about the disconnect between birth in the real world and birth as it is portrayed in popular media and its affect on women and men and how we understand birth.

Portrayals like the seething Katherine Heigl, stuck sitting on a bed while an OB bitches her out in Knocked Up may be funny to those of us who have felt the intensity of birth turn us into warrier women but it doesn’t really have anything to do with reality. That’s not what birth looks like. That’s entertainment. Unfortunately, these days, entertainment is where our culture defines itself.

People grow up believing that birth resembles what it looks like on TV and in movies.

I wrote about the problem with in my article Media and the Problem of Surgical Birth. I called out the writers and producers of that show for failing women by showing them a totally unrealistic labor turned emergent surgical delivery, complete with doctors yelling at mothers and the general dismissal of birth plans or any kind of ideal of a physiologically normal birth.

Amy’s article For Better or For Worse? Childbirth in Popular Culture quotes Pop Culture blogger Mallory saying:

“Childbirth in Hollywood movies is from a male perspective; rarely does childbirth show angles from the female viewpoint during the actual birthing.

We show killings, bombings, shootings, rapes and torture in movies, so why not show a woman giving birth accurately? Is it really that obscene and disgusting?”

What a bell ringer that is! That comment really resonated with me. So, I thought I’d take some time to detail a movie scene about a physiologically normal birth from a woman’s perspective:

Camera pans around a hospital room. It is dim, only the light behind and above the bed is on. Noone is on the bed. A nurse is off to the side checking a monitor. A husband in crouched in a corner rummaging through a back pack, looking for something. The camera pans back and forth slowly then tilts down to the bed where we can see hands and forearms, belonging to a woman , holding up the person who is the camera’s perspective.

We hear slow, deep breathing, the way one does when they have ear plugs in. The breathing becomes more deliberate and forceful and the camera tilts back up to now see the husband on the other side of the bed in front of the camera, holding an ipod, smiling into the camera with a loving look. His face is tired but not his demeanor.

Man: You’re doing such a great job, babe. I’m so proud of you.

The image dims and goes nearly black – the woman has closed her eyes.

The sound of even, forceful breathing is changing to a more open mouthed humming that slowly becomes louder.

A female voice says in a low, quiet voice, “good, that’s good, just like that. Ahhhhhhhhhhhhhh, feel that pressure roll through you and away. Take a nice deep breath and blow the pressure away.”

Another female voice, a little louder and a little more chipper says, “when your contraction is finished, I’d like to check your blood pressure, if that’s ok.”

The woman in labour says, “Mmmmmm, uh, yeah, ok.” And opens her eyes.

Cut to, image of woman leaning against a hospital bed. She is in a tank top and yoga pants. Her hair is pulled up into a sloppy pony tail. She blinks against the light as if she’s awakening from a nap.

A man offers her a drink of water from a cup and straw, which she drinks, and a woman, her doula, is behind and wipes the back of her neck with a cool cloth. A nurse begins wrapping a blood pressure cuff around the woman’s upper arm and proceeds to pump it and check the pressure.

Woman: “That one felt really intense and I’m starting to feel some pressure in the middle of the contraction.”

The doula: “In your bottom? At the peak of the contraction?”

Woman: “Yeah, I think I might try sitting on the toilet. I think I might have to go to the bathroom.”

The doula smiles and meets the nurse’s eye. A silent exchange takes place and the nurse nods her head. The doula meets the man’s eye and gives him a big grin as if to say, “this is great!”

The doula: “That sounds like a great idea. As soon as Kelly is done taking vitals, we can do a few contractions on the toilet and you can see if you need to pee or anything.”

And, scene!

In my experience, this is what birth looks like. It’s mundane and quiet and without any sense of panic or urgency. Most births are low risk and stay low risk, so with some preparation and good support, most women can have a birth that looks like this and not like this:

Ask, Don’t Tell

This post is for the What Not To Say To A Pregnant Or Labouring Woman Blog Carnival hosted by Rebirth Nurse.


If there is one thing health care providers (doctors, nurses, midwives and, yes, even doulas) should never say to a pregnant or labouring woman is “I’m going to…”. *

If I can act like your doula right now, let me advise that you should be wary of when people tell you what they are going to do when you are pregnant or in labour. You should be screaming mad when they do things without even telling you! But, you should definitely expect to be asked every time anyone on your pregnancy and birth support team wants to do something to you.

Your body is your body. Your baby’s body is your body. You are in control of all decisions but the most urgent emergency care of yourself. And, that being true, your care providers should be asking you for your permission before they do anything.

All too often in my position as an observer at births, I hear doctors, nurses and midwives tell mothers “I’m just going to see if I can stretch your cervix” when they give vaginal exams. They tell mothers, “I’m going to break your bag of waters and get things moving along better, here.”  “I’m going to put the pitocin up again.”  “I’m going to order another ultrasound.”  “I’m going to keep you on the monitor.”

It is exceptionally rare that I hear, “Can I?” “Can I stretch your cervix?” “Can I touch you here?” “Can I increase your pitocin dosage?”

There are a couple reasons for this. Some health care providers see so many women every day they all begin to blur together. They say and do the same things over and over so many times that pregnancy and birth care becomes routine to them. Watch how a nurse talks to you while you are pushing. Most nurses don’t usually look at you, their comments lack enthusiasm, they may give directions or words of encouragement when you aren’t actually doing anything and they repeat the same phrases over and over again. Some health care providers go on auto-pilot and stop paying attention to the mother and start only attending the monitors or the vagina.

Some health care providers believe, whether actively or subconciously, that women are not smart enough to make their own health care decisions. Some truly believe they are smarter than women’s bodies and the babies that are being born of them. Those health care providers often don’t think a woman deserves to be asked permission, that asking permission undermines their power over each woman or that they are above having to ask permission from mothers.

Finally, asking instead of telling means a health care provider must then explain whey they believe a procedure or therapy is beneficial. And, that takes time. And effort. And a a desire to empower the woman to make informed decisions. The pros and cons of a decision must be outlined and weighed. Most health care providers just don’t have the actual working time or the patience to do this.

When we don’t ask a woman’s permission to touch her body and to perform procedures we are doing her a grave disservice. We are controlling her. We are concealing information from her. We are taking her power away from her. We are stripping her of her individuality.

“Can I?” is such a profound improvement over “I’m going to.”

“Can I press on your tailbone? I think your baby might be posterior and a lot of women in your situation, feeling discomfort in their tailbone, really like the feel of pressure on that part of the body.”

“Can I stretch your cervix a little because you had a LEEP on your cervix that left a bit of scar tissue and I’m certain that if I stretch the cervix a little and break up that scar tissue your labour will start to progress at a much more efficient rate. Of course, on the down side, it will hurt a while I do it and if I don’t do it, I suspect it will take longer for your cervix to dilate than otherwise.”

“Can I break your waters? I believe at this stage of the game it’s the appropriate tool to augment your labour. It can increase your contraction strength which should move your labour along a bit faster and keep you in a steady labour pattern. But, if I do that, you won’t have a cushion of water to buffer the contraction because your baby’s head will be pressing directly on your cervix and we’ll be putting you on a theoretical clock and want to see this amount of progress in this time frame or we’ll have to consider further interventions…”

When heatlh care providers ask a woman for permission to do the things they believe are medically beneficial for a pregnant of labouring mother and baby, they participate with the mother in a conversation. The conversation is the process of health care, a process the mother has a rightful place in making the final decisions.

This approach to care also has another profound impact on mothers: it make them more confident. It tells them that they are smart, that they are reasonable and that they are powerful persons. Merely asking a mother for permission to do event the simplest things – “can I massage your hand for you during your next contraction?” – can put her in a mental place to meet and overcome the challenge of increasingly intense contractions where she may have cowered if treated as an object.

If you are a health care provider, challenge yourself to always ask permission when you care for women. Such a simple thing can have a positive effect on maternal and fetal health.

If you are a mother, be on the lookout for health care providers who ask instead of telling. And, if you find yourself being told, learn to say, “wait. Please explain this to me.” And after you get the information you need, you grant the care provider permission – or not.

*I’m pretty sure that I often fail to ask permission when I work with labouring mothers. I’m not perfect. I’m working towards perfection! And, the majority of birth workers I have come across are not out to strip a woman of her autonomy, certainly not on a conscious level. Most birth workers I’ve had the pleasure of dealing with have been very caring. But I definitely believe we can all improve the way we care for women at their most vulnerable time of life.

Apologies For Any Inconveniences

Over the next few weeks Hamiltondoula.com will be receiving a major facelift. Since I’m a great doula and not a professional web designer, things will be a little weird around here for a few weeks.

The changes should NOT interfere with your ability to find articles written by Leanne Palmerston or information about Hamilton Doula.

When the changes are complete, Hamilton Doula will be full of great information and even easier to navigate than before.

If you are looking for a doula in Hamilton, Ontario, check out what Hamilton Doula can offer you as your family grows : For Pregnant Families. Then contact Hamilton Doula for a free consultation.

Barter Opportunities At Hamilton Doula

45In this economic climate, Hamilton Doula is always willing to explore alternative means of payment. From payment plants to bartering, I’m willing to make getting a doula easy for you.

Discounts

If you pay your full fee when you sign your contract, I will give you a 10% discount. * That means, if you pay for Premium Doula Services, which includes birth support, education and postpartum support, you’ll get $99.50 off if you pay the entire amount when we sign our contract.

Payment Plans

If you split any amount into enough parts, anyone can afford a big ticket item. With that in mind, Hamilton Doula offers you the opportunity to break your fees down into as many parts you need to get your full fee paid. A $250 non-refundable deposit is due when you sign your contract, but after that you can choose to pay the remainder of your fees on a monthly, bi-weekly or quarterly basis.

For example, if you choose to purchase Advanced Doula Services, which includes birth support and private childbirth education, you can pay $250 when we sign out contract and then pay $150 for two months and then $175 at 36 weeks. As long as your fees are paid in full at 36 weeks, I’m open to receiving your payments on a schedule that works for you and your family.

Bartering

Bartering is an ancient economic system where people exchange goods and services of equal value. If you have a skill or create a product that is of use to me and my family, I will trade doula services with you, bartering a portion or all of the fee.

For instance, if you are a massage therapist and are interested in Basic Doula Services, you could barter a series of massages equal to the cash value of your contract. Below is a list of current barter oppourtunities. If you or your partner have a skill or product you believe I might be interested in but that is not listed below, please contact me with a proposal.

  • Massage Therapy: Honestly, who wouldn’t want to barter for this wonderful service!
  • Food prep and services: do you bake, cook, specialize in a cuisine?
  • Hair Care: Cut, colour and style services required.
  • Seamstressing/Sewing: I have a few items requiring fixes and alterations as well as a few patterns that I would like sewn.
  • Original Artwork: Every home looks better with original art and I am always hoping to discover work to beautify my home.
  • Recording Studio Time & Production Services: I’m looking for a few hours of recording time as well as production services. If you have a full studio, home studio or a high-end remote rig, I need to record a few tracks.
  • eCommerce Services: I’m looking for assistance with creating an online eCommerce system for information productions, in addition with assistance creating the information products.

Volunteer

Families with a genuine financial need deserve quality care during their childbearing year, too. This is not a service for the rich and many families who may have been able to easily afford a doula last year may have gone through a layoff or incurred new debts due to the current economic climate.

If you are unable to pay for doula fees, you may apply to have my services for free through the DoulaCARE Volunteer Doula Program. Just email DoulaCARE and tell them you’d like me to be your doula but need volunteer services and they’ll help you out. Everyone deserves a doula and your ability to pay should not be a barrier to getting care.

Doula services are valuable; talk to me about how I can make payments work for your family. Email Hamilton Doula to book your consultation today and lets talk about how I can help you build a strong family through doula support.