Sunday, December 30, 2007

Birth Messages II

A few posts back I said I'd write about my awful lesson in birth messages. I have started this post repeatedly and can't find a satisfactory way to tell it. In the interest of getting it "out," I'll just go with this one.

Several years ago I posted on this blog my account of a Cesarean birth I'd witnessed. I attended the birth as a doula. I was very upset about the birth and wrote candidly and angrily about it.

My anger was directed at the doctors who had, in my opinion, pushed the mother into an unnecessary C-section. These same caregivers then treated the surgical birth (again, in my assessment) very disrespectfully. I had wanted a different experience for my client. I tried to say this in my post. Because of my anger, I spoke in very harsh terms about this birth, ultimately comparing it to "a fuck." Not words I usually use, but they conveyed how vulgar I'd perceived this experience to be.

More than a year after I'd written the post, I ran into that client. We had a friendly chat. I was happy to see her and her child thriving. In telling her about my doula work I mentioned that I wrote about it in a blog and gave her the name of it.

Four months later I received certified mail from DONA saying I had had a grievance filed against me by a former client. I thought it must have been a mistake. I hadn't been at a birth in many months and couldn't think of a client with whom I'd had negative interactions. Even when I turned to page two, the official grievance letter filed by the client, and saw that it was the client from my story above, I couldn't imagine what I'd done to cause her to file a grievance. Hadn't I just seen her recently and gotten a hug from her?

Her letter told the story. That night she had gone home and found my blog -- this blog. She went through my archives to the time of her birth and read the posts leading up to and including the one detailing the birth of her child. She said she felt "horrified and betrayed" to have her birth defiled by such ugly words.

I, too, was horrified. I re-read my post through her eyes. I would have been shocked to read about the birth of one of my children told this way. Even if it had been a "bad birth," I would not have wanted anyone else to say so without my consent.

This posted a dilemma for me as a doula and a blogger:

To what degree am I able to blog about births?

The answer is not easy. DONA provides some direction. Its code of ethics and standards of practice instruct that we must keep confidentiality for our clients. Hence, I not only refrain from identifying clients' names, children's genders, occupations, home cities and hospitals of delivery, I also blog anonymously myself. This is all intended to keep someone from reading this blog and saying, "Hey! She must be writing about my sister-in-law!"

Still, applying those standards to my posts didn't really help. I had kept confidentiality by not revealing my client's identity or mine in any way. But I still had been deeply hurtful.

One could argue (and several friends did) that as long as I kept my client's identity secret, I could write whatever I wanted about her birth. After all, my experience as a doula was as important as hers as a mother. I am permitted to have my own reactions to births -- including anger -- and this is a forum for sharing those reactions. Another friend pointed out that a lot of non-fiction writing makes people angry, in large part because they do not like how they are portrayed. This disconnect is unavoidable and I am not under any obligation to mediate it.

While I agree with the truth of these viewpoints, they do not sit right in my doula heart. Just because one can do things that may ultimately be hurtful, does not mean one should do these things.

The best argument I can think of for writing about births, consequences be damned, is that advocacy involves telling the truth. I believe the birth system in America is messed up. I can provide first-hand accounts of how the status quo is not always in women's best interest. If those who witness birth wrongs don't talk about them, how will people know things need to change?

Yet even this argument ultimately pales to the sanctity I with which I want to approach birth. I ultimately decided that I will not post birth stories on this blog without the mother's approval. In effect it means I have stopped posting birth stories. I can't quite bring myself to say, "hey -- now that you've given birth, will you read my account of it and give me permission to put it on my blog?" It makes me feel less like a doula and more like a voyeur.

I miss sharing birth stories. Many of the stories I told were wonderful ones. Stories of strength, joy and satisfaction. I do no miss the voice in the back of my head saying, "what if she reads this? Will she know it's her? Will she be surprised you noticed X?"

The most recent International Doula included a piece on internet ethics. I was excited to see it, hoping we could begin to establish some norms for blogging in the birth community. But the example they used was a much easier one of someone referring to a client by first name and other identifying information in a chat room.

Please feel free to weigh in and also link to any relevant posts out there. I know many of you have been writing and thinking about this (as well as the disappearance of many great birth blogs including FP Mama and Red State Moron).

p.s. I long ago removed all old birth stories from the blog except a few for which I had don't bother trying to find the one above or any others.

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Wednesday, December 26, 2007

Christmas Knitting Composite

I'd hoped to get all the recipients in one place at one time, but that proved impossible. So instead, here are the 4 hats I made for my co-workers:

clockwise from top left:
There are two things about the hats that especially pleased me:

1. ALL are from stash yarn! No new yarn was harmed in the process of making these hats.
2. The recipients either were fine actors or genuinely liked their gifts.

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Friday, December 21, 2007

Thursday night quarterbacking

as overheard in our kitchen at 10:00 last night:

me: These cookies are taking a LOT longer to make than I expected. I mean, the dough was a snap to mix but baking and cooling each batch...c'mon!

spouse: Well, you know what they say.

me: Yeah. The really great ones can always step it up a notch...

spouse: Dig a little deeper...

me: Build on a small change in momentum...

spouse: Fight through adversity...

me: Move. I gotta get to the oven.

I am a holiday baking warrior.

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Tuesday, December 11, 2007

Season of Hope

I hope you will share my joy in learning that my clients whose son was stillborn in September, 2006, are pregnant again and eagerly anticipating the live birth of this child in late April. Hold them in your loving thoughts.

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Monday, December 10, 2007

What to Expect when You're Expecting...Menopause (and Beyond)

Of course I jest. I would NOT want a book patterned on the infamous What to Expect series.

I would, however, find it interesting to know what lies ahead for this womanly body of mine. Just as people only share the horror stories from birth or puberty, aging women only lament hot flashes and whiskers.

How prevalent are these things? Like monthly bleeding for young women, are hot flashes unavoidable for aging women? Am I destined to grow facial hair (or take estrogen to counteract it)? Are the effects variable? I have to think they are. My periods are crampless, 2-3 day affairs. My sister's are week-long near-hemorrhages. Will one of us gently recalibrate our hormones in 15 years while the other rushes -- as our mother does -- from one temperature extreme to another?

I also wonder how much I don't even know about. I still remember the evening 5 years ago when my aunts were together for an annual gathering and the eldest, near 80, talked about her "pussy lips hanging down to my knees." Ever since I've entertained that image with a mixture of horror and fascination. Do labia lengthen? What else happens that no one talks about? I've seen one elderly vulva and was surprised to find it largely bald. I have no idea if most women lose pubic hair or just the woman I saw.

So elderbloggers (are you reading, LRH?), let us younger gals know what lies ahead. Give us stories of strength and hope...and honest accounts of the changes to expect.

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Tuesday, December 04, 2007

Doula : Midwife :: ____________ : ____________

You remember these from the SAT, right?

communication : telephone :: _____ : scissors

a) blades
b) metal
c) cutting
d) tool

I LOVED those kind of questions. And I just learned they're a lot easier to answer than to compose! But I digress.

In a previous post Kim asked what the merits/overlap would be in having both a doula and a midwife. I get this question from prospective clients all the time.

The answer (chime in doulas, midwives, moms with experience in this arena) is that because the midwife is responsible for your and your baby's health and well being, and the doula is responsible for your comfort and confidence, there's little overlap in the written job descriptions. The merits of hiring a doula -- continuous physical and emotional support during labor, education and empowerment in advance of labor -- are the same whether your health care provider is a midwife, family practice doctor, or OB/GYN.

In reality, things aren't exactly that cut and dry. If you are planning a homebirth, your midwife is likely to bring a team that includes her assistant and an apprentice. Because you're at home, your overall level of anxiety is probably going to be lower than at the hospital. And because you're planning a homebirth, you can handpick your birth support team to include the family and friends you think will best encourage and hold you through the process.

It is quite likely that in this environment, a doula will duplicate much of the support you'll already have present. Your need for reassurance will probably be lower and you'll have more people to provide it. I'm hoping this is the reason I have never gotten an inquiry from a prospective doula client planning a home birth. She doesn't feel she'll need anyone else.

While this is likely true, I would argue that doulas have a place at homebirths. Midwife friends have said to me that a common misconception is that your midwife will also be your doula. She will not. The midwife has a unique charge that includes making judgement calls about what's best for the mama's and baby's health. She might want to rub your back or hold you in the birth pool, but if heart tones are low, she'll have her ear to the doppler. At that time, the extra presence of a doula could be invaluable.

Similarly, some small number of homebirths end with an unplanned transport. When the midwife takes a patient to the hospital, she (usually -- see my midwife-blog-heroes for some hopeful counterexamples) loses any status as care provider. Depending how hostile the hospital is, the midwife may not even be allowed to go in with her patient. The doula might be one of the few people who could be present at home AND in the hospital to provide that continuity of care.

If you are talking about having a hospital birth with a nurse midwife, then the doula is every bit as important at that birth as at a physician-attended birth. CNMs in the hospital setting may be juggling multiple patients. Nurses definitely will be. Hospital policies will take priority over your and the midwife's preferences in most cases. For these reasons, a doula is a good idea. She can help you advocate for your wishes. She can help bring new CNMs and nurses up to speed at shift changes. She can be there with you every minute, even as the midwife pops back over to the clinic to see patients and the nurse checks in on her other beds.

A big advantage to having both a doula and a midwife is that they tend to be favorably disposed toward each other, at least from a professional point of view. Midwives usually view doulas as an ally. Doulas are more inclined to trust midwives' motives than O.B.s'.

My two cents is that the decision to hire a doula should be determined by where you plan to birth, rather than whom you plan to have catch your baby.

And now, any thoughts on completing the analogy above? It's hard because each of them has a relationship to the birthing mother but not to each other. Give me your best shot, but I think there is no relationship analogy between them.

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Sunday, December 02, 2007

speaking to and sitting in classes

Friday I gave a presentation on doulas to a "Childbirth and Culture" class at the U. Discussing doula work is one of the easiest things to do for me. I could do it at length without any prep. I did prep, of course, only to spare the folks in the class a disorganized rambling.

Besides the typical things you'd expect -- how I became a doula, what doulas do, what doulas can't do, how I find clients -- I talked about tensions in doula work. Tensions are where things get interesting. Tension is key to any story, even one about the work of a doula.

Some of the tensions I discussed (in no particular order) were:

    Wanting to serve high needs women (i.e. those who have socio-economic issues that match or overshadow their birth support needs) and the additional demands those clients often place on one's emotional/mental/psychological reserves.

    Wanting to make a living as a doula while charging a reasonable (employable!) rate to one's clients.

    Refraining from bringing one's own advocacy/political/personal agenda to births; i.e. remembering these are the clients' births, not one's own.

    Being an advocate for one's clients without speaking for them.

    Doing something versus doing nothing (when doing nothing may be the best course of action).

    Balancing doula work with other work and/or with having a family of one's own.

    Being hired by the client but working in a hospital setting (where one can be removed by the hospital).

    Working alongside extended family who offended by or skeptical of your presence as a doula.

There are so many others, but these came easily to mind. For "comments" fodder, what else am I missing?

I then spent yesterday at a day-long training on post-partum home visits and how to make the most of them. It was a very good session. The morning was all about postpartum depression and psycho-emotional adjustment to motherhood. I now am armed with the EPDS and plan to screen all clients postpartum. And when I find one who may have PPD, I know what to do in terms of helping with referrals, etc.

The afternoon was about maternal recovery, infant care and safety and other more routine postpartum situations. Much was a review, but I picked up some good tips as well as new ideas for how to structure my postpartum visits.

I'm a bit "doulaed" out at the moment, but glad to have had some significant chunks of time devoted to thinking about this work.

Thanks all for the recent comments. I'm reading up on the sources you suggested, am planning to follow up to Marianne's tagging, and will definitely expound on Kim's question about doulas at homebirths.