Nannies and Baby Nurses and Postpartum Doulas, Oh My!

So many families these days are realizing that when a new baby comes along an extra set of hands may become necessary.  And many women now a days do not have immediate family members close by or even in the same country to help out when baby arrives.  So these smart families are turning to outside help.  

The options available to new families is vast.  From Nannies, to Baby Nurses, to Postpartum Doulas and more.  But what is the right choice for you? 

First you have to decide what it is you are looking for? Do you want someone to look after your baby for you?  Do you need someone to look after an older sibling while you look after baby and recover?  Do you need someone to help with baby and you and assist with breastfeeding? Are you worried about postpartum mood disorders? Do you need something completely different? 

Let's look at a few of your options?

Nannies are generally used to look after older babies and children and follow the instructions given by the parent. They often live in with the family and don't usually assist with housework or laundry or caring for the postpartum mum.  They are not trained in breastfeeding support or in recognizing postpartum mood disorders.  They often work with families for many years. 

Baby Nurses are usually hired to care solely for the baby.  They too are not hired to assist mum with her postpartum recovery, take on housework or do laundry.  As with Nannies, Baby Nurses are not trained to assist with breastfeeding, though if they have had babies of their own, they may have a basic knowledge.  And as their primary function is to care for baby, they are also not trained to recognize postpartum mood disorders or look after older children.  Baby Nurses also must be trained nurses if they are using that title.  

Postpartum Doulas are trained to work with families in the first few days, first few weeks, first few months after baby comes home.  They are hired to support a new mum and her family while she recovers from her birth.  Their main priority is the mum.  Helping her with breastfeeding support, making sure she is eating, letting her rest while the doula watches the baby, listening to her process her birth experience and recognizing if mum is experiencing any postpartum mood disorder symptoms.

Postpartum Doulas will also help with educating the new family on all things infant.  How to bath and diaper a baby, tips for helping to soothe a crying baby, baby wearing, showing families real life hacks on how to cope with a new baby in the house.  Postpartum Doulas educate and support with the latest, up to date, evidenced based information and not just anecdotal suggestions.  

Postpartum Doulas will help with light duties around the house including mum and baby's laundry, cleaning the kitchen, preparing meals and anything else that might alleviate any stress from mum so she can concentrate on her recovery.  They can also help when there are older children in the house, keeping them entertained and happy to ease the pressure off of mum or watching baby while toddler has some mummy time, so they don't feel left out.  

Postpartum Doulas are also trained in supporting a family that may have been blessed with more than one precious bundle.  When babies come in multiples doulas can be that extra set of hands either during the day or over night when having more than one newborn can be overwhelming.  

Postpartum Doulas also support the rest of the family, including partner and grandparents, by modeling helpful support of the new mum and baby, answering questions, offering resources and educating everyone to help bridge the gap between old traditions and modern practices.  

We as a society were never designed to raise our offspring alone.  Like our ancestors so many generations ago, we are supposed to have our babies and raise them in a community, surrounded by our women, our mothers, sisters, aunties and grandmothers.  Being supported while we recover and learning from these experienced women on how to care for our babies.  Today, however, we are disconnected from our families either by distance or fractured family dynamics.  Yet we still need the support to make mums recovery quick and easy and to learn the many things associated with having a baby.  Mum still needs to have the tools to feel confident in her role as mother and nurturer and she can't get that from a book or the internet.  New mothers need mothering.  Postpartum Doulas are a great option for women and families that want more from their postpartum experience.  

So if you are having a baby, think about what you need, what you want. And consider hiring a doula for you and your newly expanding family. 

I Want To Become A Doula!

When I gave birth to my third child almost 10 years ago I did so with only the support of my partner. We didn't think we needed anyone else with us.  We'd done this before.  Twice.  My partner was great, but the birth was a bit of a farce.  I was induced in the morning and by the afternoon things were progressing quickly.  I did not have an epidural as I had the first two times and my partner needed to stay with me the whole time.  He could not leave my side.  I needed him.  But as a result he was not able to eat, drink, or go to the bathroom.  When it came time to push the deprivation he had endured for eight hours took its toll and he fainted.  The staff were more concerned about him than me and my perfect birth was out the window.  After the birth I experienced lots of Breastfeeding issues that ended with my daughter back in the hospital.  I later suffered from postpartum depression that ultimately took over my life.  If we had support during the birth or the postpartum period I do believe things could have ended differently.

I became intrigued with the aspect of support during birth and the postpartum period and did some research.  By fluke I came across the profession of "Doula".  But how did one become a doula? How did you make this a profession?  I'm often asked this now as a doula trainer so I thought it would be a good idea to lay it out here for everyone to see the steps involved.  

When I first began my research there were really only two organizations that were available to choose from, especially for a Canadian.  I looked at both and sought some advice of other doulas I had met on line in doula chat rooms, remember this was before FaceBook.  One doula in particular suggested I look at each organization's Vision Statement, Position Paper and their Approach to Birth. When I did I found I was drawn to the Vision that CAPPA had toward birth and their doulas. So now I had a path. 

I started with the labour doula workshop.  It was two days and explored a doulas scope of practice, the stages and phases of birth, comfort measures, how to support women and their partners during labour, how to handle unexpected outcomes, how to support a cesarean section or a VBAC, pain medications and the doulas role, supporting Breastfeeding and offering resources to pregnant women and new mums, the business side of your job and finding clients and oh so much more.  It was amazing! 

I walked out of that workshop as a doula in training.  I could now work with women and support them in their births.  During the early years of my doula life I continued to run my Home Daycare.  The families I served were very forgiving if I needed to have my husband watch the kids or my Mum or had to call in sick one day every now and then.  I also spent a number of years working at Shopper's Drug Mart and had a younger teenage cashier agree to take a shift on a moments notice if I had to go to a birth.  I also found like minded doulas who I got along really well with and we worked as back ups for each other.  I was nervous giving up guaranteed income for the risk of being self employed, so in the beginning I took just one a month, and worked slowly to gain experience and immerse myself in the birthing community.  One day I realized I was becoming popular, in demand and I had to make a decision to either do this "doula thing" or quit.  By that time I was also a Childbirth Educator and Postpartum Doula.  So while my income was not Millionaire worthy it was comfortable enough to take away my safety net.  And I'm so glad I did.

During those early years I was also working on the steps to become certified.  Being certified was important to me because I believe if you are going to do anything, you do it right and you do it fully. These days being certified is becoming more important as our profession becomes more popular and clients are now requesting certification.  And, as we creep ever more closely toward regulation, certification will definitely become a requirement.  

The steps to labour doula certification are many but not difficult.  And CAPPA allows 2 years for you to work on these steps.  I also used an extension which was easily granted as CAPPA understands that life happens and family comes first.  

Steps to Certification- Your Road Map To Becoming Certified:

(For the sake of this piece I will discuss the current steps to certification as things have changed slightly in recent years. You should always check the CAPPA website for the most up-to-date list of steps)

The order in which you do these steps is not important except for signing up for CAPPA Academy.  CAPPA is unique in that it has an online certification process.  All your documents, forms, exam and steps are found in CAPPA Academy.  

Once you have signed up then you would be free to tackle the steps as you see fit.  Those steps include: 

- Become a member of CAPPA.  As a member and a trained doula you will appear in CAPPA's referral section so expectant and new parents can find you.  You do not have to be certified before you appear on the website. 

- Complete the preworkshop study that you would get when you register for a workshop.

- Read the manual that you will get and go over extensively in the workshop.

- Read 5 books from the reading list.  You'll probably read more than that as you find books that peak your interest and expand your knowledge. 

- Complete part one of the HUG Your Baby Training program.  This program gives professionals strategies and tools to help prevent or solve problems around newborn sleep, eating, playing and attachment.  Professionals will be able to boost parent confidence, enhance Breastfeeding and promote bonding. 

- Create a resource list that you can use to make referrals to new mums and expectant parents.  That list would include lactation consultants, support groups, midwives and more. 

- Attend a Childbirth Education Class.  

- Attend a Breastfeeding Class

- Pass the multiple choice and essay exam found on CAPPA Academy.  This is an open book exam so no need to worry. 

- Attend three births and have them evaluated by the labouring mum, her primary care provider (Doctor or Midwife) and her secondary care provider (nurse or secondary midwife) for a total of nine evaluations. 

- Sign and agree to CAPPA's Code of Conduct and Social Media Policy, Grievance Policy, Missions Statement, CAPPA Approach / Philosophy Statement, Vision Statement and Scope of Practice. 

And that's it! Once you have completed these steps you gather everything together that needs to be sent in to the office, make copies and send those copies in.  Give the amazing office staff 6 weeks to mark your package and if all is in order you will receive your certification and be able to use the letters CLD next you your name. 

When I received my certification from CAPPA it was one of the proudest moments of my life.  I am so thrilled to be a member of and trainer for CAPPA.  This organization is a true sisterhood of support.  Their motto is "Love Wins!" And they truly mean that! 

So if being a doula is something you have thought of, or you have more questions about how to become a doula you can check out CAPPA's website at www.cappa.net or find workshops on my website at www.torontodoulagroup.com/becomeadoula.htm or you can email me at kim@torontodoulagroup.com. 

Being a doula and childbirth educator is the most rewarding job I've ever had and I can't thank CAPPA enough for being such an amazing, supportive and forward thinking organization.  

The Real Doulas of Toronto!!!

As a doula I've spent almost 10yrs meeting and working with amazing women in the birthing industry.  No two of us are alike, except perhaps for our passion for supporting mothers, babies and their families.  So I thought wouldn't it be great to highlight for the people of the Greater Toronto Area and beyond some of the utterly fabulous women I work with on a regular basis.

I've set it up like an interview with their responses below.  The first doula I'd like you to meet is Carrie Barr.  Not only is she an amazing mom but an incredible birth and postpartum doula.  She would definitely be on my team should I ever become pregnant again....which I'm totally not....ever....and I mean ever....Carrie is one of our Durham Doulas.  So if you are pregnant or a new mum in the Durham Region, you need look no further than Carrie!

So without further delay, here is Carrie Barr!!!

1.  What brought you to become a doula?

I was fascinated by people's birth stories and horrified at the number of people coming home thinking they had an "emergency" section for blah, blah, blah reasons and would never have a baby normally.

2.  How do you think postpartum and birth doulas benefit parents?
Birth doulas help empower a couple for the birth experience they want, doulas reduce interventions and increase chances of successful breastfeeding.

Postpartum doulas help integrate the new family member into the house, provide breastfeeding support, create a longer breastfeeding relationship, provide sleep support and help design a postpartum plan for the family.

3.  Besides Birth support, what other related services are you passionate about?

Placenta encapsulation, waterbirth and every woman having access to support.
4.  Would say it is still important to have a doula with Midwifery care?
Absolutely, while midwives are amazing support they do not have training in comfort measures like doulas do and they have tons of charting to do which occupies their time.  Doulas and midwives make an amazing birth team.
5.  If you attend births in hospitals which is your favourite and why?

My favourite is Port Perry because it's small, quiet, and the staff have time to be attentive, they LOVE having doulas, the birthing suites are on the main floor with it's own entrance and the rooms overlook a private garden so women have a beautiful private view while labouring.  And they can walk in the garden!! No need for the blinds to be closed and the sunshine shut out!

6.  One of the biggest concerns is that doulas will replace the partner, how do you ensure that this is not the case?

I always tell clients that I am there to support both of them and that I always offer to show the partner what the client needs so that he/she has the opportunity to be involved on whatever level they are comfortable with.

7.  What questions do you feel are important to ask a birth and or a postpartum doula?
Experience, references, bias's, back up

8.  If you could put together the perfect support service package what would you choose?
All my services! A tub rental for a homebirth in which I was the birth doula, who then encapsulated her placenta and do 6 weeks 5 nights a week of pp support

9.  How do you juggle family and doula work?
I try to focus on services that allow me to be at home like tub rentals and encapsulation, I do pp nights so I am here when my family is awake, limit births to 2 a month and try not to take any when I have pp booked.
10.  How do you answer the question "You're a Do-What?"I provide professional support to pregnant and labouring women and sleep and breastfeeding support to families at home after the baby has been born!

10 Reasons Not To Not Hire A Doula

I read a blog entry recently about doulas called “10 Reasons to not hire a doula”.  It was, according to the author, meant to be a parody.  As a doula I found none of it funny.  And actually was annoyed by its perpetuation of the doula stereotype.  So I decided to write a rebuttal.  I’ll try for humour as best I can and I hope to not anger anyone in the process of examining the “10 Reasons not to not hire a doula”.

Point one, Expense.  Yes Doulas are an out of pocket expense for most people.  And as the writer of the blog was American who probably has to pay medical expenses to have a baby I can see where this would be an issue.  In Canada we spend our money on the acres and acres of crap you don’t need when you have a baby.  Thousands of dollars in nursery furniture and décor in a room your child won’t even use for the first 6 months of their life, clothes from Old Navy and Baby Gap that your infant will enjoy spitting up on and pooping in.  Have you experienced the explosive poop? You better hope it isn’t in the $40 Gap onsie, cause no amount of Oxyclean will get that stain out.  And what about the $50 Nike baby running shoes? You squeeze them onto your baby’s potato shaped feet and if you’re lucky you won’t lose one in the mall, never to be seen again. 

Perhaps saving some of that money to spend on the day of your birth might be money better spent.  When you are 90 years old and you can’t remember what you had for breakfast that day, you will be able to recall your birth.  You probably won’t be giving birth 20 times like Michelle Duggar so why not make the experience as calm and stress free as possible.  Having a doula helps you be involved in the birth, have your questions answered and makes you feel a part of the birth and not that the birth just happened to you.  Also for the dads, we make you guys look like rock stars.  We show you how to help and let you be as involved as you want to be, at your own comfort level. 

And if the expense is still too much for you, many doulas work on a sliding scale or you could get a doula-in-training who may work for expenses or free. 

Point two, apparently all women just want to get the baby out as fast as possible. Funny, this is the precise reason to hire a doula.  Studies have shown that having a doula has been instrumental in shortening the length of labour and decreasing the severity of the discomfort felt.  I really don’t think I need to say more on this one. 

Point three, “A doula may try to talk you out of having drugs.” That is crazy.  I’ve had two epidurals and they are wonderful things.  I’ve also done it without drugs.  I would never talk a momma out of having an epidural unless her baby was sitting on her perineum.  This is not the doula’s birth.  Its the momma’s birth and if she wants drugs, no problem.  Hook her up.  If she doesn’t, I can get her to the end.  If she wants to try to go as long as possible without, I’m there.  Whatever momma wants, momma gets.

Point four, if the doula becomes a peppy cheerleader, the author will punch her.  Well so would I.  You hire a doula that fits with our personality.  If you are dragging and the end is overwhelming you we can be peppy if that’s your style, we can be strong and tough, we can be the shoulder to cry on, we can give you hints and tips to get you over that hump.  So I encourage you to interview several doulas to make sure you find the right doula for you, one that fits with your personality.

Point five, Doulas do not offer the doctor help.  We are not medical.  We assist in comfort measure suggestions, tidying the room, helping mum shift position, getting cold cloths and ice chips, supporting mum’s leg during pushing, watching dad so he doesn’t faint, but never suggestions on momma’s medical care.  That’s just crazy.  Doulas help parents make decisions by ensuring they have all the information and in order to do that we read lots of studies, on the internet.  But we help parents navigate the crap that can be found on the internet so what they know is evidence based and up-to-date.  Though I’ll admit, there is the odd doctor I’d love to see have a head explosion, that is out of my scope of practice.   And I’ll address the “hippie” comment in point nine.

Point six, I agree you shouldn’t have dozens of people in the labour room.  But the people you have shouldn’t be spectators either.  The people you invite to your birth should be helpful and encouraging and supportive of your choices.  That may not be your mother-in-law or you teenage sister.  Birth is not a spectators sport.  It’s an intimate experience that you will remember for the rest of your life.  So choose wisely.  And as for the oblivion mommas used to experience and get their babies three days later?  Well in my opinion, that’s what’s wrong with the world today.  We are a messed up society because we messed up birth for so many generations.  I’ll jump off my soap box here as I could go on a tangent.

Point seven, Breastfeeding. Yes we help with breastfeeding.  If you don’t want to breastfeed that’s your choice.  Doulas support choice.  Many mommas though want to breastfeed and it isn’t easy.  The most successful breastfeeding mommas are those that have support at home and can have their questions answered and latches checked.  But if you don’t want to breastfeed, doulas can help in giving advice on safe formula feeding. 

Point eight, lady bits? Really? I can’t even come up with a decent response to that one. 

Point nine, Crunchy granola hippie doulas.  Let’s see, I shave my legs and arm pits, wear make-up, dye my hair and get my nails done every two weeks.  I recycle and compost because my city requires me to, not because I want to and my car is far from eco-friendly.  As doulas go, I’m lumpy oatmeal at best.  I don’t say Yoni. I say Vagina, because that’s what it is.  I don’t chant or wear flowy skirts and beads.  I wear high heeled shoes not Birkenstocks.  I have never been a hippie and would never be accused of being one.  This point is the one that irritated me the most.  I don’t have a problem with my doula sisters who are crunchy, they are beautiful women.  But that’s not who I am. 

Point ten, the best point. Postpartum Doulas are awesome and very helpful in assisting new moms in the early days and weeks of motherhood.  They help with breastfeeding, making sure mom is getting rest, getting good food, having her house tidied and her questions answered, all without judgment of her choices.

Look, having a doula isn’t for everyone.  But having a stereotyped opinion of a doula and knocking them without really knowing who we are or what we do is just bad form.  So the next time you’re pregnant or the first time, look at what you want for your birth and the experience you will hold for a life time and consider the benefits of hiring a doula to ensure you get the birth you want, whatever it happens to look like. 

Did you know that in most hospitals you are allowed two support people? Presumably one will be your partner and the second can be...your friend, a family member, or a hired professional called a doula.  Having an extra set of hands to assist you and your partner can be very beneficial.  In the case of a doula, The assistance comes without judgement and with an expertise in modern birth and a knowledge of the workings of the hospital.

But what if you were told by your doctor that they didn't allow you to have a doula?  Do you think your doctor has the right to dictate who your support people are? One such incident was highlighted to me earlier this week and it got me thinking. 

Consider this, what are the chances your doctor will actually be at your birth? Having a doula offers you continuity of care.  Your own doctor can't offer you that.  The vast majority only work at their hospital once a week or less.  And as most hospital policies do not dictate the precise "who" you can have, where is it coming from that your doctor can say precisely who will be there to support you?

One reason could be that the doctor has had a past bad experience with a doula and has written off the entire profession.  A situation of one bad apple spoiling the bunch.  But like with all things, there is good and bad.  There are good doulas, and bad doulas.  Just like there are good doctors and bad doctors, good nurses and bad nurses.  But you might agree, that one bad experience shouldn't ruin the experience of all mothers and shouldn't take away a woman's choice for her own birth.  If we did that, then most of us wouldn't be seeing doctors at all, or going to hospitals. 

A second reason might be control.  Some doctors, not all, like to micro manage birth.  They like to control the process and don't like to answer questions.  Some feel the questions you ask are actually you questioning them as a doctor and as a professional.  Some think the doula is whispering in your ear and getting you to make decisions that go against medical advice, or that the doula is bad mouthing them behind their back. 

Nothing could be further from the truth.  A doula is there to support your decisions.  To help you in physical comfort and evidenced based information.  To remind you of your birth plan, that you and your doctor agreed to.  To help you cope when things don't go as planned and to be with you even when everyone's shift has ended.  They are not there to make decisions for you, but to help make sure you have all the information to make an informed consent decision.  And informed consent is your right as a patient. 

So what is a parent to do when confronted with having to choose between the birth team she wants and not upsetting their care provider? The easy answer is nothing.  It shouldn't be a choice.  Your birth should be what you want it to be.  With a care provider you like, who is supportive of your choices, in a place where you feel comfortable, either at home or a hospital or a birth center.  With a team of supporter of your choosing who will care for you, listen to you, and be with you every step of the way. 

But how do you do that? Research.  Interview, yes even doctors.  Go on tours of different facilities, ask questions, ask your friends, family, co-workers, prenatal teacher.  Research on-line, read books beyond What to Expect When Your Expecting.  Pregnancy and birth are all about choice.  Don't have that choice taken away from you because of fear and ignorance. 

Partners.....

What is the role of the partner in the birthing room? For so many generations partners either didn't want to be in the birth room or were barred from being there.  Women were surrounded by their female family members and women in their community.  They were supported with love and compassion and the skill of women who had birth before them.

These days the skill comes from doctors and nurses and midwives.  And the love and compassion comes from their partners.  This can put many partners in an awkward position.  To see the woman you love, in perceived pain, and unable to sympathize or make it go away.  Desperately trying to remember what was said in the prenatal classes, kicking yourself for not reading those pages she had flagged for you and scrambling to find the birth plan she printed off to bring to the hospital.  What is a partner to do when suddenly faced with labour day and being overwhelmed and under prepared?

Step One:  Remain Calm
Even if you are freaking out on the inside, stay strong and in control on the outside.  All that comedic drama we see birthing mothers and their partners pull in the movies is FICTION! She needs your strength even when you aren't feeling it yourself.

Step Two:  Be There
That may seem obvious but I don't mean just physically.  You must be there mentally as well.  So that means no iphone, no blackberry.  Watch her, not the monitors.  Hold her hand, rub her back, listen to her wants and needs and respond to them.  Don't be distracted by the buzzing of your phone with texts and calls from anxious family members.  They can wait.  She needs you now.

Step Three: You are Papa Bear
You are there to protect your family and make sure they are safe.  How do you do that? Ask lots of questions, follow your gut and don't assume every suggestion is right for your family.  Most protocols are based on averages.  And your woman is not average.  She is an individual and her birth is as unique as she is.  She should be treated as such.  Protect her and her space so she can feel safe enough to let go and work at her labour.

Step Four: Plan Ahead
You can't show up for the birth and expect awesome.  No one wakes up one day and decides to run a marathon and win. You have to train or your twitter feed from the finish line will end with #fail.  Listen in prenatal class and practice the comfort measures you are taught.  Most importantly create the birth plan together.  This way you will know what she wants and why and how important each item is to her.  Know what you are fighting for when you are Papa Bear. 

Step Five: Know Your Limitations
Know what you are capable of.  What are your strengths and weaknesses? If you cannot do steps one to four with 100% of your abilities, get help.  Preferably a Doula who will assist you in all your steps and do it so you end up looking like a rock star.  Take all the credit, she won't mind.  Being honest about your ability to assist momma and asking for help is what she needs.  Being macho is not a welcome trait in the labour room, but honesty is.

Answer these questions: Can you be all she needs? Can you handle everything you may face? Do you have the stamina to run this marathon with her? If a voice in your head said no at any point, ask for help.  She'll love you for it in the end. 

My Completely Biased Favourite Places to Give Birth in Toronto

I currently teach prenatal classes at York Central Hospital. Because the program is run by an outside organization I often get couples that are having their babies in other hospitals. I realized the other day that I have an obvious bias toward certain hospitals. So as such, I thought I would try to keep my biases out of the classroom and share them here instead.  

Sunnybrook - Having your baby at Sunnybrook is a definite experience. If I were to have another baby and had to have a hospital birth it would be here. The facilities themselves are practically brand new. Private labour rooms double as your postpartum room and are roomy with most medical equipment actually hidden behind cabinets and stored away. The bathroom holds a wonderful deep tub with jets and room for partner should they choose to join mum in the water. And there is optional dim lighting in there too. And the most practical touch of all, a mini fridge to hold your drinks and food to use during labour and postpartum.

But all that is just window dressing. The staff make your birth experience at Sunnybrook truly fabulous. The nurses, who are your main contact at the hospital, are definitely there for you. Whether you are choosing an unmedicated birth or are looking forward to your epidural, the nurses will be there to assist you in executing your birth plan as best they can. I have rarely seen women pressured in to procedures they don't want to the sake of expediency. They are open and friendly and caring. The doctors as well are a rare breed in the world of maternity care. Several I have seen are open to choice, one was even supportive of a clients desire to have her baby in water. Something we only really see with midwives and homebirths. Whether you are hoping for more then 5mins in your appointment or delaying your cord clamping by 2hrs, there is a doctor at Sunnybrook for you.  

Toronto East General - Until Sunnybrook came on line, Toronto East was my top pick for hospitals in Toronto. Like Sunnybrook the staff is fabulous. The nurses are kind and caring and the pressure to get an epidural is minimal. The facilities themselves while older are still good, with big rooms and tubs in almost every room.

The doctors are also unique in offering breech vaginal delivery and discussing choices with informed consent as opposed to pressuring patients into what will work best for the doctor and their schedule. Toronto East General is also one of only two hospitals in Ontario that have been awarded an official Baby Friendly Hospital by The World Health Organization and Unicef. Not even Sunnybrook has this. As such they also have an amazing breastfeeding clinic to help you in getting the support you need in that critical time after birth when you and your baby are learning to breastfeed.  

Mount Sinai - While many doulas would not even have Mount Sinai on their list at all, I have had too many good experiences not to have them on my list. Mount Sinai is the only hospital where my clients have not ended up in a cesarean section. Almost 30 percent of my clients have birth there and none have had a surgical birth. That's amazing. While the facilities are old and in the process of being updated, the staff are fairly good with staff who are open to natural birth, even if they don't always understand a woman's desire to go natural. I have seen women pressured to accept interventions simply to speed up the process, but if you enter into your labour with a plan in mind, educated on your options and with good support who will advocate for you then you may not fall prey to unnecessary procedures.  

The Others - The rest that round out the list include North York General, of which I have a certain fondness, having been born there myself. Markham-Stouffville, for its recent achievements in reducing their cesarean section rates. And Scarborough Grace where I had my own children with an amazing OB.

So that is my completely biased list of hospitals in Toronto. If your hospital isn't on this list, odds are it isn't one of my favs. But I'm just one doula. Your birth will be what you want it to be and what you allow it to be. But wherever you are having your baby I always recommend a doula to help you get the birth you want.

Pleasant Hospital Experience

It has been just over a year since SunnyBrook opened their doors to their new Women and Babies unit. I had not had the opportunity to attend a birth there until this past weekend. As it was, it was not my client but I was called in to back up my partner. I was extremely impressed.

The facilities were beautiful. Of course it still had that shinny new feeling to it and the paint was probably still wet but it was nice none-the-less. The room had a fabulous deep tub and the room was large and spacious. And to my delight there was a private mini fridge for mum and partner to bring nutritious snacks and drinks, or a small bottle of champagne. And best of all you don't have to keep food in a communal fridge to be stolen by others.

But beyond the cosmetics and bells and whistles of the hospital, one of the best things about this hospital is the staff. The first nurse I met was Aggie. I had met her when this program was done through Women's College and she is still a fabulous, friendly and caring care provider. Then we met Karoline and she was equally wonderful and caring. The doctor who came on shift while I was there, Dr. Nevo and the resident Stephen (I didn't catch his last name), they were both very patient and spoke calmly and slowly about what their recommendations were and what the procedures would entail. This goes along way to making a potentially stressful situation easier for mum and partner.

Unfortunately for our client the end result was a cesarean section but for the comfort and support of both mum and partner, the doula, me, was allowed to attend the section as well. I was very happy for that, as the situation did require more then one set of hands to keep mum calm and comfortable for the hour it took to complete the procedure.

Overall, the entire experience was more then I could have hoped for, for any couple having a baby. The respect for birth and women and their ability to give birth is a rare gem in our world today. While the bells and whistles are great, women have been giving birth without them since the beginning of time, but what they have always needed to give birth is kindness, caring, support and above all respect. And SunnyBrook Health Sciences Women and Babies Program has that in spades.

Can't wait for my next birth there.

Your Cervix and Emotions are Linked!

Were you aware of that? That your cervix is directly related to your emotions and stress levels? I'm sure it makes sense and if it doesn't then read on.

This weekend the Toronto Doula Group had two clients who's labour was directly linked to their emotions. The first, a client of my business partner, went into labour on Thursday. This was her second child and the contractions were about 7mins apart. As this was her second they opted to go to the hospital. Once there it was determined that she was 3cms, but her contractions had slowed down a little.

The client then decided that she would rather go home to labour a little more on her own. The nurse told her that it wasn't a good idea because she wouldn't know what was going and it would be safer to stay. She still refused and was next confronted by a resident. The resident told her that she needed to stay so her baby could be monitored and it was safer to stay then go home. (How did we manage to survive as a species without doctors and monitors???) She still refused and was getting upset about the way she was being spoken to. At this point her contractions had all but stopped. Finally the doctor came in and began to get belligerent telling her she couldn't leave and it was putting her baby in danger. He was headed for a cesarean section and would come back in an hour to discuss her nonsense.
After an hour and no contractions at all she got dressed and left. Unfortunately she was required to sign a "Against Medical Advice" form.
Over the next couple of days whenever contractions started and she began to think about going to the hospital, they would stop. She soon began to think about changing health care providers.
After some relaxation and fear release her water broke on the Saturday night. Her baby was born healthy and safely 4hours later.
It isn't fair for health care providers to undermined their patients wishes with fear and threats. If she had stayed like they wanted and not followed her instincts she could have very well ended up with a c-section. Something no one should have because of fear and tension inflicted on them at a time when things should be calm and stress free.

The second client was mine who was having a VBAC or Vaginal Birth After Cesarean. She had been using Hypnosis to remain calm and even to turn her baby to a head down position. Everything had been going well and her doctor was very supportive. He kept everything laid back and calm and even though she was approaching her due date, he had still not scheduled a c-section. Unfortunately at one week past due things changed and he told her sharply that she had run out of time and 72hrs from that day her section was scheduled.

This left my client in a panic. She had been having start and stop contractions (common for vbac mothers) for a couple of days and was shocked when she was given no time to discuss her options. She spent that weekend searching out an acupuncturist to help and took homeopathic remedies to help as well and again had start and stop contractions. She did several fear releases and worked hard on relaxation. But there was one thing still holding her back.

The impending c-section. It was causing her stress and tension in her body and until that was released her contractions would continue to stay blocked. We had a long conversation and she decided to call the hospital in the morning and explain her situation. The act of making that decision let her contractions change and begin to get stronger and closer together. She needed to release that fear and stress and let her emotions go so she could let her body do what it needed to do.

So how does one do these things. Hypnosis. Having a Doula. Getting practical and non-fear based childbirth education.

Unmedicated Birth

Is it possible in this day and age to have an unmedicated birth? With all the media attention on planned c-sections and the world of famous people spouting the necessity of pain medication and planned inductions for timing when your baby comes. (Don't get me started on that one)

I think it is possible, if you truly want an unmedicated birth. There are just a few things you need to do in order to increase your odds.

First off, have a midwife, family doctor or an OB who is laid back and supportive of natural birth. Find a health care practioner who believes in what women's bodies can do. You aren't looking for a surgeon. You are looking for someone to assist you in birthing your baby.

Secondly, work with a doula to help guide you and support you and be you and your partners advocate in achieving a natural, unmedicated birth.

Thirdly, choose your childbirth classes wisely. Choose non-hospital based childbirth classes, where you can discuss options for pain such as birth balls, tubs, showers, massage and more.

Fourthly, choose a hospital that has such things as tubs, showers and supports natural, unmedicated birth. Yes they exist.

Fifthly, let go. You cannot control your labour. Your body knows what to do, you have to have faith that it will do it. You need to let your body go, get into the contractions and let them do their job. You have to surrender to them and let them work at bringing your baby down dilating your cervix.

The value of a supportive word...

This was not the topic I was intending to write about but sometimes situations arise and you can't help but voice your outrage and concern.

A friend recently came home from a VBAC birth and told me how the doctor basically told her client to stop wasting her time, it was just going to be a ceserean any way, he refused to take responsibility for her and that walking around was a complete waste of time. The client did everything she could and my friend had her doing things we never knew a labouring woman could accomplish while in active labour.

Unfortunately after more then 24 hrs it did end up in a ceserean section.

But why would a doctor come into a hopeful and happy situation and burst every balloon in the room with his words. When a woman is in labour she is so open to the connotations of words. A woman who feels supported and loved and safe will do amazing things during her labour. Her discomfort will be diminished, her labour will go faster, she will not fear the process and listen to her body, and she will preceive the birth in a much better light regardless of the outcome when her basic human needs are met.

Now I'm not saying that in the case of my friend her client would have had a vaginal birth if her doctor hadn't been such a mean guy, but perhaps she would have had a better outcome, a more pleasant experience, a shorter experience, who knows.

Kindness costs nothing, it doesn't infringe on our health care costs but the benefits are huge and it would go a long way if doctors and nurses and friends and family would remember that when talking to a pregnant or labouring woman.

That's my soap box for today, perhaps I'll get to write the next post I was planning on and chat about why you aren't too fat, short or old to have a baby.

How to Hire a Doula?

The last few weeks I've been hearing a lot of people ask questions about hiring a doula and what to look for. In fact just yesterday I recieved a call from a woman who had been 'chatting' with a woman who claimed to be a doula and it all sounded very suspect. In fact she had originally spelt the word doula wrong. My advice in that case...run away!

So I thought I'd put a few things down that will help the novice pregnant family look for, interview and hire a doula.

First!
Why are you hiring a doula? Do you even know what one is?
"A doula is a professional who provides emotional, physical, informational and practical support for the expectant, laboring or postpartum mother. She does not perform any medical tasks but actually compliments the medical birth team."1

Consider what you kind of support you are looking for. How do you envision your birth or postpartum period going? Do you need support during your pregnancy and labour? Then you are looking for a labour doula. Are you looking for support after you come home with the baby? Breastfeeding support or help with twins? Then you are looking for a postpartum doula.

Many doulas are both labour and postpartum doulas so if you need or want both then you need to ask the doulas you speak to what their services include.

Second!
Where do you find a doula?
Ask your friends and coworkers if they had a doula or if they know someone who did. Word of mouth goes a long way in hiring a doula. If that search leaves you empty handed turn to the internet.
You can start by a google search. "Doula Toronto" and see what you get?
Or you can search the many different doula referal sites such as:
http://www.torontodoulagroup.com/
http://www.doulacare.ca/
http://www.babyontheway.ca/

Third!
Once you've found and called several doulas (you can email as well but I suggest calling) get a feel by the ones you speak to who ou might like to meet in person. Each doula should offer a 'no obligation, no cost' interview to chat and answer questions with both you and your partner. If they don't, then they are not the doula for you.

I suggest interviewing 3 or 4. If you only have one or two that's okay too, but make sure that the doula you hire is the one for you. If it doesn't feel right or you just don't connect with the doula then they aren't the doula for you. Keep in mind too that the doula has to get a feel for you too. If she does not feel the connection then she may decline being hired. Don't take it personally, if she's not feeling it then she won't be at her best for you when you really need her.

But what do I ask?
You want to know where they trained? When they trained and if they are certified. Being certified is not the be all and end all but it is an extra step in training that I feel shows dedication to their field and respect for their training and continuing education. Now you may find that a doula you really connect with is in the process of getting their certification or has done a hundred births but is not certified. Don't worry.

As long as they are trained by a reputable training organization and is a member in good standing then you are good to go. As I said, being certified is not the be all and end all so don't get hung up on it if the doula you like isn't certified.

Fourth!
Check their creditentials. Go to the websites of the organizations they trained with or call them and see if they are a member in good standing. Are they a member of any other organization, call them and see if they are a member in good standing. If they aren't, you won't be able to find out why but that is a red flag! run away.

Fifth!
Ask questions. Labour Doula
What made them decide to become a doula?
How long have they been a doula?
How many births have they done?
How many births do they do in a year?
What do their services include?
Do they work with a back up Doula?
What are the terms of their contract?
What additional services to they offer?
What is their childbirth philosophy?
What is their opinion on pain medication?
When during the labour do you call the doula?
Do they have references?
Where and with whom did they train?
Cost?

Postpartum Doula
What kind of training and experience do they have?
How do they see the role of the doula?
What kind of services do they offer?
Are there different packages available?
Ask for references?
Why did they decide to become a doula?
What do they find is the most challenging aspect of their work?
How will they help the partner/family/older children?
Do they have back up?
What can you expect from a typical day?
Do they help with breastfeeding?
Are they opposed to bottle feeding?

Finally, I've alluded to training organizations. The two main ones are CAPPA, and DONA.
Have a look at their websites, you'll be able to find doulas on their sites too.

http://www.cappacanada.ca/
http://www.dona.org/

And trust your instincts! Hiring a doula is 50% experience and 50% personality. There is a doula for every woman and a woman for every doula. You'll find the right one, she's out there waiting for you.

1. The Doula Advantage by Rachel Gurevich - available a most Chapter and Indigo stores.

Hypno...what?

"You should read, Hypnobirthing by Marie Mongan." I say in all seriousness. Instantly a look comes across their faces and you can almost read their thoughts. 'We can't hire her, she is way too crunchy granola for us...' or 'Hypnobirthing...what kind of crazy mumbo jumbo hippie crap is she talking about.'

The funny thing is, I'm not crunchy granola, more like lumpy oatmeal and hypnobirthing, despite the name is not mumbo jumbo.

Contrary to popular belief Hypnobirthing will not allow your partner or me to make you bark like dog or act like a chicken during labour. It will however allow you t become completely relaxed and free of tension. When you are in this state, you are better able to listen to your body and follow your instincts.

You will still be completely conscious but during your contractions or surges as they are called, you will be able to go into a deep relaxation with the help of breathing and imagery.

Some of the best birth's I've been to have been Hypnobirths and my clients have been able to go unmedicated, and have been relaxed and stressfree.

So whether you take the classes or just read the book, I suggest that this state relaxation is something you should strive for in your labour. And it isn't surprizing for me to say that having a doula will aid in that goal

Well at least I'm not the only one saying it!

Medical interventions in childbirth adding undue risk

UPDATED: 2009-01-28 12:14:10 MST

By THE CANADIAN PRESS

TORONTO - The group representing Canadian obstetricians and gynecologists says there should be fewer medical interventions used in low-risk pregnancies.

The Society of Obstetricians and Gynaecologists of Canada says doctors should be promoting “normal childbirth” to women who seem unlikely to undergo difficulties during delivery.

A new policy statement from the group says the number of medical interventions used in healthy pregnancies is on the rise and could be subjecting mothers and babies to risks they don’t need to take.

It says health professionals are turning too quickly to interventions such as caesarean sections, induction of labour prior to 41 weeks of pregnancy, and the use of forceps or vacuum assistance during delivery.

The statement says doctors should only resort to these types of interventions when there is a valid reason, and should not use them when labour and birth are progressing normally. (But then I ask, what is normal for one my not be normal for another)

Supporters of the statement include the Association of Women’s Health, Obstetric and Neonatal Nurses of Canada, the Canadian Association of Midwives, the College of Family Physicians of Canada and the Society of Rural Physicians of Canada.

“We are seeing a significant increase of medical intervention during childbirth, but there is a real concern that unnecessary interventions introduce risks for mother and baby that could be prevented,” says Gisela Becker, president of the Canadian Association of Midwives.

“We want to be sure that women who are at low risk for complications receive adequate information and support to have a normal birth.”

So then we need to remember or rather have faith that women's bodies were designed to do this particular job. Without assistance from drugs, contraptions, monitors and what not. Women who have a team to support her, to help her feel loved, safe and supported will labour at her own pace follow her bodies own natural tendencies and birth her baby safely and easily.

Why must we send women into hospitals only to be hooked up, told they aren't labouring effectively, tell them their contractions are ineffective, basically saying you can't do it and then pump her full of drugs to force her baby into being born when perhaps they weren't ready.

My favourite saying from a renowned doctor I met was..."Nature doesn't screw up that badly. Human's screw up, but not nature." So why must we constantly believe that nature doesn't know what it's doing?

Pleasantly surprized!

I spent Valentines at the birth of a wonderful couple in Women's College Hospital. The birth was wonderful, everything went very well. So why was I pleasantly surprised? My only experiences with this hospital was one birth with midwives and several women telling me that their doctor was insisting they not have a doula.

One woman, a single mother with only her elderly mother for support asked her doctor about getting a doula and he told her it wasn't necessary, that he would be there and doulas were not worth it and would ruin their birth. She was a candidate for a volunteer doula and was the one person who really did need a doula. Thankfully she didn't listen to her doctor and had a doula and that took a lot of pressure off her and her mother to be there all on their own. Their doctor was not there for her, he wasn't even there for the birth.

My client this weekend told her doctor that that she was having a doula. He told her that their doula "had better watch her place. I'm not talking to her about you." I was worried that this doctor would ban me from the birth. He had some chip on his shoulder that a doula would encourage a client to go against their doctor. That a doula would give medical advice. That simply isn't the case. Doulas are not medical. Our role is to comfort, physically and emotionally. Our job is to educate and make sure that when a client has a big decision to make they are doing it with all the information.

So when I entered the hospital I was concerned that I would not be able to support my clients to my fullest abilities. Turns out the only problem I had was the incredibly small room. The nurses were awesome and respected my role on the team. The anesthesiologist was fabulous and let me stay for the epidural despite the size of the room. Her doctor went off shift and the new doctor was great and very pleasant.

I was very pleased with how everything went and stayed longer then I usually do. I'm actually looking forward to my next birth there.

2009 is the year of optimism

So I'm feeling particularly optimistic these days about what 2009 has to offer. Let consider 2008 as the year of trial and error. I had some awesome births, I had some that were horrible and one that was completely devestating to me and made me question my strength to continue on in the birth world. I took courses, I learned lots, not only about birth and breastfeeding but about myself. I became a stronger person. I became a better mother, a better wife, a better daughter and a better doula.

2009 will see the birth of many babies and also the birth of a new chapter in my doula life. This chapter includes new training, a new partnership and the birth of a new organization. The Toronto Doula Group will be emerging and taking on the doula world by storm.

I'm so excited about this and I know that there is only good things ahead of me in this brand new year. So watch out, I'm here and I'm not leaving.

Inductions suck! (A Very Tired Rant)

Let me start by saying that for some, inductions are necessary. Those women with high blood pressure or PIH, those with gestational diabetes and those who suffer from other illnesses that may threaten their or their baby's life. For them inductions have saved lives.

Having said that, for women who are "past date" or their water has broken or their doctor is impatient inductions SUCK!

The main reason being that they are designed to fail. Lets consider how it goes:
The pregnant mother comes into the hospital with the belief that her baby is 'overdue', 'very large', 'her water has broken 24 hrs ago', or they had thought they were in labor and the hospital was not busy and even though they were only 1 cms dilated they were kept and given a room. (Hint, go home!!!!)

She is told, for whatever reason, that she will need to be induced. The reasons given sound grave and usually the mother is so sick of being pregnant it is a straw she can't help but grab.

And thus it begins.
She is sent to a room. Forced into a hideous blue gown with her butt exposed. Propped up all comfortable in bed, (The first of the problems). Attached to fetal monitors (The second of the problems) and either her water is broken or she has an iv started and is pumped up with pitocin. (The third of the problems).

If the induction begins with breaking her water, there is usually a shred of hope in that she is able to walk around at least after a little bit of monitoring. This is good and necessary because women need to move in labour.

If she has pitocin then she is doomed. Women in labour can't remain in bed, unless their body is telling them too. Being on pitocin she must stay monitored and thus stuck in bed. Thus begins the interventions.

An epidural follows because the contractions she is getting from the pitocin are unnatural and very painful and being stuck in bed she can't move around to find a comfortable position. You can try sitting in a chair or standing or even on the birth ball, but heaven's forbid she should move because then the monitor won't pick up the baby and the nurse has to reposition it until the baby can be 'found' again and that usually involves the mother being uncomfortable and begging for pain medication.

Thus the epidural now has slowed the labour and mom isn't labouring at the rate she should. According "the text book" you should dilate at a cm per hour once you hit 4cms. Now because of this delay the pitocin is continuing to be increased. After a while the baby may not tolerate the pitocin contractions and the heart rate will dip repeatedly and the pit is stopped but the contractions do too and then the cycle starts. After a while, usually just enough hours to really drain on the mother and her partner the doctor mentions the dreaded "C" word. At this point, the dips on the monitor have scared the parents, they are exhausted and just want to see their baby and be done with it all.

Thus the end of the induction is a c-section. Failure!

So then what are you to do? First off get as much information as possible before you are induced. Ask the following questions:
"Am I or my baby in danger?" If the answer is yes then you have no choice and the induction is necessary.
"What happens if we wait a little longer?" Most of the time it will buy you some time and if the answers you get are satisfying to you then, wait!
"What happens if we do nothing?" Again, more time is bought and you get more information to make a sound decision about the care you are going to be receiving.

Don't blindly jump into an induction without all the facts.

Second, there are lots of great ways to get your body ready for labour:
Massage, accupuncture, chiropractics, sex, and more.

Try everything else first.

Well that is my rant for the day. In case it wasn't obvious I had a failed induction on the weekend and while mom and baby are doing great I'm saddend by the fact that she missed out on the birth she was hoping for.

Therefore: Inductions Suck!

Skeptic Nurses and doctors.

Why is it that whenever a woman dilates quickly, that nurses are so apt to disregard their pleas that they need to push or they need to be checked.

I've had two, no four incidences where the hospital staff thought my client was either lying or simply over reacting.

One occurred back in 2007 and I had a volunteer client. When we get to the hospital my client is doing really well and then around 2:30pm is checked and is found to be 5cms. A few minutes later the doctor comes in and they want to put a scalp monitor on her because they are having a hard time getting the baby's heartbeat. While the doctor is fiddling around with the package I sense my client pushing and ask her if she is and she says she can't help it. The doctor is still fiddling and I say that she is pushing and the nurse is convinced she is pushing on a full cervix. I try to tell her to breath through the contractions but she keeps insisting the baby is there and then that the baby is out. The doctor and nurse are completely ignoring her and then when the doctor lifts the sheet to insert the scalp monitor, there is the baby! Head out, ready to have the shoulders birthed. That was at 2:50pm. It was crazy but shows that women know their bodies and the medical community don't trust what the woman says about her experiences.

I bring this up because it happened again last night. My client whom I had just met as I was called in for back up was assessed in triage and found to be 1-2cms. They came to the hospital early but given that their drive was over an hour, mom felt like she needed to be there. I always say, if you feel like you need to be there, then you need to be there. They called and told me it was early but I felt like I should go, (I was already half way there) to meet them and get to know them a little. I met them in the hall, they were sent for a walk and had basically had taken 20minutes to walk up the hall and were on their way back down. Her contractions were intense and over a minute long. They were coming every two minutes. Her skin was goose pimpled with each contraction, that's how intense they were. She said she felt like she needed to push and I don't take that lightly anymore. Her husband and I got her back to the room they were using to store their stuff and I suggested going to the bathroom to see if perhaps it was a full bladder she was feeling. Trying to urinate was just far too intense and she said again she felt like pushing. I confirmed with her that she was feeling pressure in her bottom and she was clearly loosing her control. I told the dad to go out and get the nurse and tell them she is feeling pressure and needs to push. "That outta get a reaction out of them" I said. The nurse came in and tried to calm her through the contractions and the look on her face clearly said "I don't believe you, suck it up." My client was begging for pain medication and the nurse finally decided to check her and in the 40minutes since they had been checked she went from 1-2cms to 7-8cms and then 20minutes later was fully dilated and pushing her baby out. She pushed for about 20 minutes and her beautiful daughter was born.

These labours are called Precipitous Labors or Precipitous deliveries. They are births where the labour lasts less then 3hrs. Some information I've read says they occur between 2 and 5% of labours and are less likely to happen in first time labours. These labours are so rapid and it is so hard to manage the pain. The mothers are literally overcome by the contractions. Epidurals are useless in this case as even if one is able to be given in time the medication will not be able to cover the intensity and or catch up with her pain. One key thing will be to remain as calm as possible and not be over come by fear and tension. I know, easy to say, harder to do. But it is critical that you let your body do what it has to do and not stand in its way.

So as a doula it is my job to listen to the woman and trust in her body and trust in her own reading of her body. She knows better then anyone what is going on and if given the ability to labour in safety and a stress free environment her instincts will rarely be wrong.

Toronto East General Hospital

Wow, is all I can say for this hospital. It was amazing. The birth itself was great. Unmedicated, my client was in complete control and she was a rock star. I'm so proud of her. And to top it all off the hospital was amazing. Great jacuzzi tub that the nurse suggested to use. (Normally I get a weird look if we ask to use the tub.) One nurse brought out the birthing bar for my client to squat if she wanted to. (Normally they pretend like they can't find it.) The room was beautiful and very quiet. The doctors were all so nice and amazing. One actually complimented me as opposed to treating me like wallpaper, and they seemed pleased that my clients had a doula. I would give my eye teeth to do another birth there. Oh wait I am. I'm jazzed to have been hired by another client who is birthing there. Yeah me. Yeah them!

All I can say is Kudos to Toronto East General Hospital, to Dr. Maya Ganz and all the nurses there as well. And finally Kudos to my client and her strength and her control.

Labour and Delivery: The Movie

Don't get excited. There isn't a new movie coming out about childbirth. I just thought it would be nice to compare movie birth to real life birth.

The Hollywood Version
Scene One:
Woman enters the hospital in a wheelchair, clutching her abdomen, screaming in pain. The husband is frantic, sweating and pale. The nurse rushes to them and leads them to a hospital room right away.

Flash to a new scene; the woman is in bed, strapped to monitors and intravenous tubing, screaming obsceneties at her husband. The doctor is looking at the chart, while the nurse reads the monitor. All the while the woman is freaking out on her poor husband, blaming him for putting her in this situation and vowing never to have another child.

Next scene, the woman is sitting forward, knees up with a sheet drapped over them. The doctor is shouting to push. The woman is sweating, teeth clenched, moaning, grunting, screaming while she pushes. Then suddenly the baby is placed on the mother's hospital gown covered chest, looking like a three month old, covered in cheese curd.

The Reality Verson:
Scene One: The mother, her husband and their doula walk into the hospital triage. They are slow because the mother has to stop every now and then to breathe through a contraction. Once the contraction ends, she begins walking again, supported by her partner. He is attentive and they appear to communicate without needing to talk.

The woman is assessed after waiting for a while in triage and then they are moved to a fairly nice room and encouraged to walk. The woman and her support team spend several hours walking, sitting on the birth ball, using the tub or shower and utilizing focused breathing.

The atmosphere is calm and controlled. The mother is listening to her body and her support people are following her lead. Every now and then a nurse appears and checks that all is well and then disappears again.

Eventually it is time to push the baby out. The mother chooses several different positions to push from and follows her instincts and eventually the baby emerges and is placed goopy and bloody on the mother's bare chest and with smiles and tears the woman kisses her newborn baby's head, while her partner kisses her head and tells her how proud he is of her.

*******************************

Okay so some of what I put in the reality version was a bit optimistic. Generally women don't get to choose their own positions but occassionally they do and of course there is usually a whole lot of time missing there but overall the moral of all this is the same; reality is much better then fiction.

So stop watching "A Baby's Story" and any other hollywood version of birth, because it is fiction. A story made up and sensationalized for entertainment purposes. Real, non-high risk birth simply isn't scary and horrible enough for Hollywood to film. Sadly though, we as women grow up with these images and horror stories from our sisters and friends and we enter labour and delivery with an expectation of how it is going to go and we end up with a self-fullfilling prophesy and get that horrible birth we were expecting. We aren't taught that birth is normal and safe and beautiful. We can birth with calmness and beauty, but we have to believe it first. So tell your friends, your sisters and your daughters beautiful stories of birth and save your horror stories for Hollywood, and may one day Hollywood will follow suit.