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!

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.

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.

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.