The day Kate called the Midwives...

Being the birth junkie that I am, I couldn't avoid all the press about the newest princess in the British Royal Family, especially considering that Kate Middleton is reported to have had a lovely, quick, uncomplicated birth.

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We'll never know all the details. I'm assuming it would be considered untoward and most certainly inappropriate to share whether a member of the Royal Family required stitches or gave birth in water or any of the other details so savoured by those who read birth stories.

But actually, it's not those details, or the lack thereof, that inspired this blog post. So in celebration of International Day of the Midwife... Here goes!

Let's start with the good news:

Duchess Catherine chose to be attended primarily by midwives, and the midwives worked as a team with the gynaecologists and perinatologist and various other designated officials.

But, what irks me is how patriarchal ideas about birth are being perpetuated in the press surrounding the event.

I hear you sigh - 'Grouchy Feminist on the loose!'

Actually, even my husband was appalled at the language used about the Duchess' birth. Let's have a look at some quotes and take it from there:

About her birth team, a headline from 'The Telegraph':

Royal baby: meet the doctors who delivered Kate Middleton's second child

Alan Farthing and Guy Thorpe-Beeston led a team of four that delivered the royal baby at St Mary's Hospital in Paddington (Ref)

This headline was followed by 11 paragraphs, or around 358 words describing their respective Curriculum Vitae and detailing how and when they met and married their wives. There was also a mention of the gynaecologist who wasn't there this time around, and even a quote by aforementioned absent gynaecologist to round things out. Interspersed in the quagmire of qualifications and dates, was one line, in the second to last paragraph:

They over saw a team of midwives looking after the Duchess in the Lindo Wing. (Ref)

Names? Qualifications? Families? Quotes? Nil. Zip. Nada. Nope.

Based in the US, the 'Boston Newstime' also published a rather extensive article detailing every aspect of the birth. In their section on the medical team, give or take 350 words are again devoted to the achievements and qualifications of the non-midwife medical team, including around 130 words about, or by, Sir Marcus Setchell, that same guy who wasn't even there. To his credit, his words did include a description of the nameless midwifery team at Prince George's birth as 'perfectly wonderful'. (Ref)

That full quote: Sir Marcus described the midwifery team as "perfectly wonderful" but added: "There are certain situations when someone is giving birth that it's important not just to have a specialist sort of available at the end of a telephone, but actually in the same room to deal with anything that's immediately going to be wrong." (Ref) (Emphasis added)

Are midwives not specialists then? Something 'that's immediately going to be wrong'? Let's give him the benefit of the doubt and assume this was just a slip of the tongue and that he didn't intrinsically see birth as an emergency waiting to happen that only someone with a Doctor's qualification could solve.


'Midwifery Team' - Names? Qualifications? No? Ok. I suppose the only qualification necessary is that the good doctor felt they were 'perfectly wonderful' - no names needed.

Princess Charlotte of Cambridge already has her own Wikipedia entry - but according the entry as it stands today (5th May 2015), there were apparently no midwives involved:
The baby was delivered by Alan Farthing, surgeon-gynaecologist to Queen Elizabeth II, and Guy Thorpe-Beeston, an expert in high-risk pregnancies and surgeon-gynaecologist of the Royal Household; both were present at the birth of the Cambridges' first child, Prince George, in 2013. (Ref)

But wait, 'The Inquisitr News', among others, reported on the 2nd of May that even though the 'suited surgeons' got most of the press coverage, they 'simply looked on to ensure that everything was going as planned ... the midwives were the ones that actually delivered both Prince George and the new Princess' (Ref)

So 'The Daily Mail' comes to our rescue, with the following headline:

Call the midwives! The calm duo who delivered the Princess after striking up close rapport with Kate

I'm so grateful they were calm. Not like those hysterical midwives you usually get...

At least here we have a mention of their qualifications:

Midwives Arona Ahmed and her boss, Jacqui Dunkley-Bent, Professor of midwifery at Imperial College Healthcare NHS Trust (Ref)

Professor of Midwifery! How delightful! 'Perfectly wonderful'! But not a 'specialist' according to the absent gynaecologist. 

The other qualifications of the midwives were summed up in the following sentence:

Both women are experienced, unflappable and have the full confidence of the obstetricians. (Ref)

Ah! There it is! You see, they had the full confidence of the obstetricians. Professor of Midwifery notwithstanding. Perfectly wonderful!

And don't get me started on how Kate was 'delivered of' her baby, as though she just lay there while someone else did all the work, or as though she was possessed rather than pregnant.

P.S. So in case you can't see what bugs me about this - it's the whole issue of gatekeeping - how is it that the men who weren't there and or didn't do anything except 'oversee' get the praise, the press and lists of qualifications and full biographies, while the midwives who did the work, whom the Duchess chose, are, on the whole, invisible, nameless and voiceless, and are qualified by the opinions of the doctors above anything else.

And then there's that line I haven't mentioned - where a number of news outlets state that Kate had opted to be seen first by midwives, and apparently a 'source' had qualified this with 'What the duchess wants, the duchess gets.' (Ref)

Like a child that wants ice-cream for breakfast.
Not like a rational adult woman with an actual choice in how she gives birth.
Perfectly wonderful!

Thoughts?  Please comment!

Enjoyed reading? Please share!

Obstetrics - Bastion of misogyny

Miso-what?

by Barbara Kruger

Misogyny (miss-odge-a-knee) literally means 'hatred of women' - but just as we understand that a paedophile doesn't really 'love' children, so the term misogyny has come to refer to having an inherent prejudice towards women, usually to their detriment.

I get that referring to obstetrics as a bastion of misogyny is a strong statement to make - Didn't huge numbers of women die in childbirth before maternity wards and hospitals and operating theatres? What is wrong with that? You don't become a gynaecologist or obstetric nurse unless you want to help women, right? How is that missy-, misod... hating women?

This has been a very difficult post to write. It is a real challenge to get the balance between describing the misogyny, if not outright abuse that women are experiencing under obstetric care, whilst acknowledging that there are many care providers who do not intend to practice in this way. I would like to put forward the idea that it is not every individual in the obstetrics industry that is consciously misogynistic (although some are), but that the institution of obstetrics itself utilizes deeply entrenched misogyny as its foundation. For one example, see here.

Therefore even those who are not personally invested in the practice of misogyny feel stuck in a system that cannot function without it.

If you are still a wary, let's try something. I found this site (among others) containing a list of the characteristics of a misogynist. If we personify the obstetrics industry, how many of the characteristics of a misogynist does it fulfill?
Before you read the list below - please remember this is not about doctors vs midwives or men vs women - I have seen internalised misogyny practiced and perpetuated by midwives and doctors, male and female. I believe we are dealing with a system that is inherently misogynistic, but is allowed to continue as such because women are told that the misogyny is for their own good. 

Characteristics of a misogynist:

•  Controls women by destroying their self-confidence
• 'Are you sure you don't need an epidural?' (x10)
• *checks dilation* 'You are only 3cm dilated.'
• 'Failure to Progress.'

•  Needs to ensure that women are always less powerful than he is
• Stirrups
• Lithotomy position
• 'My gynae said he/she will/won't let me...'

• Intimidates women by constantly finding fault with them
• 'Let's see if this naughty cervix is behaving.'
• 'This perineum is far too small - we'll need to do an episiotomy.' *head not even visible*
• 'Be quiet - You're making too much noise!'
• 'What size shoe are you?'

• Humiliates women in public and devalues their opinions
• *Calls the doula over to show her why the episiotomy will be necessary and why more time won't help by demonstrating how 'small' the mother's vagina is with his two fingers while she has full sensation and without her consent.* (Mother is on her back. Ends up cutting three times.)

• Must ALWAYS win in a discussion with or about women – all encounters with or about women are seen as a battle to be won.
• 'Well if you want to have a doula you'll have to find another gynae...'
• 'Well, you can either listen to me or you can have a dead baby.' - otherwise known as playing the 'Dead Baby Card'
• 'You know you can't trust Dr Google,' when a mother tries to present a peer-reviewed journal article on how delayed cord clamping may be beneficial.

• Blames women for failings that are in no way related to them
• 'Failure to Progress' is often more a case of 'Failure to Wait'. When a mom is strapped to monitors and not allowed to stand up and eat and be normal it is no wonder that labour stalls!
• 'We'll have to give formula because your milk hasn't come in yet.' *Less than 24 hours after birth.* Anyone who knows the least bit about breastfeeding knows milk only comes in at around three days after birth. 
• 'It seems your pelvis is too small to deliver this baby.' Said by the same person requiring the mother to be on her back in the position most likely to restrict opening of the pelvis.

• Blame women for his own failings and shortcomings
• 'The Caesarian rate is so high because women's pelves (pelvises) are getting smaller.'

•  Denies women's feelings and makes them wrong for feeling them
• 'It wasn't that bad. At least you have a healthy baby!'

• Makes jokes or derogatory comments about women and then ridicules any woman who gets offended or upset

• Belittles or ignores women's accomplishments
• 'It must have been the atarax.' *After mother reached 8cm from 3cm dilation in 3 hours through some Rebozo sifting, moving around and changing positions.*

• Has no remorse or guilt for the pain he causes women
• 'But I saved you!'

• Tries to keep women from doing things they are qualified to do
• Like being able to make decisions about what they do with their own bodies.

•  Selectively quotes authorities to substantiate his views and positions on women
• 'Cochrane Review? Pfft! I only trust the British Medical Journal on these matters.' i.e. the extent of his research is on how to do better surgery, not on how to avoid surgery to begin with.

• Will confuse issues by changing the subject, denial, word jugglery, lying, twisting the facts or acting as if nothing happened
• 'If you tear, it will be jagged and we will have to cut the jagged edges off and then sew it together.'
• 'Your baby will drown if you give birth in the water.'

• Is preoccupied with sex and is sexually controlling
• Ever heard of the 'husband stitch'?
• 'Don't you think your husband would rather you had a Caesarean?'

• He has problems with authority figures in general and women in authority in particular.
• Outspoken and experienced midwives (as opposed to obstetric nurses) in general and private midwives in particular are often seen as the enemy and are accused of giving women all sorts of crazy ideas.

• Has a Jekyll and Hyde personality - Nice to you in public, but cuts you down in private
• 'My gynae is very pro-natural.' *When I know his CS rate is over 85%*
• 'My gynae is very happy for me to try for a vbac.' *When I know the success rate of VBACs in that hospital is less than 5%*
• 'My gynae said I can have a water birth.' *When the midwife on duty says she's never seen this doctor allow a first time mom to deliver in the water.* 

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So before you start roaring at me in ALL CAPS saying that birth attendants aren't all like that, I totally agree. I know some truly incredible birth attendants and caregivers who have utmost respect for the birth process and birthing women. But they struggle in a system that does not represent these ideals. Read Dr Gauri Lowe's account of her obstetric training as a GP here: Thoughts on expecting natural birth service from your doctor...

Even though all the quotes above are actual quotes or situations I have heard / experienced / read, I understand that they do represent extremes, and yes, I understand that many individuals do not consciously perpetuate these misogynistic language and behaviour patterns, but until someone calls them out, the abuse will continue. A woman should feel safe and secure and supported no matter what her race or social class or education or risk category. 

Edited to add:
In describing obstetrics as the last outpost of misogyny, I don't intend to minimise other expressions of misogyny, both explicit and implicit, but I do feel that obstetrics is a particularly well guarded bastion of the ideology, because it is one of the most widely accepted and widely justified areas of misogyny. In short, 'It's for their own good.'

Further reading: 

Birth: A surprising history of how we are born by Tina Cassidy (On Takealot)
Dr Robbie Davis-Floyd (Anthropologist) - Articles on Childbirth and Obstetrics

The doula as a witness

I love that I learn from every single birth I have the privilege to attend. Each family and each birth requires different things from me - different words, different actions, different energies. Part of the skill in being a doula is knowing when to use which words, actions and energies. 

At times I stand by as a quiet presence, at other times I am in constant contact. Some moms prefer silence, while others want distraction. I rub feet, hands, hips, legs, backs and shoulders, I stroke hair,  I whisper encouragement, I turn down the lights, I turn up the heat, I fill the pool, I bring cool washcloths, I hold the space, I keep everyone fed and watered - doing my best to remove any hindrances to the birthing mother. 

I do all these things, but I feel they are all secondary to my role as a witness.   Of anyone involved in the birth process this one is almost unique to doulas. Partners are present but the birth is their own birth experience too. The midwife, the nurse, the doctor - they have their own responsibilities that often involve papers, numbers and tools - they have additional concerns that I don't have to carry. I am able to be there - truly present - with all my energy and attention focused on the birthing mom. I know midwives who choose to be fully present with the birthing mother, but these are rare.

And so I often get to see the things that others don't. I witness a birthing mother glowing serenely through yet another wave; the gentle interactions between a mom and her partner; the dad's face as he marvels at what he and his partner accomplished. I witness the mother's triumph as her dreams and expectations are clothed in flesh.

I am there for the disappointments too. I witness the moment when the gynae orders a second caesarean section after a long battle for a VBAC. I am there when her wishes are disregarded and her body violated with impunity by those with greater authority than me. 

In those moments something in the depth of me rages.  I don't dispute the medical justification for their actions, but too often there is little to no acknowledgement of her desires, her struggles, her strength, her autonomy, her personhood. 

Something in me rebels at the idea of being complicit in a system that routinely disregards evidence-based care in favour of convenience, that favours policy over personhood.

While this system rolls on, someone has to mop up the emotional fallout after institution has done its work. While there is little I can do on my own to improve the care women get while giving birth in our birthing institutions, I can bring empathy - the ability to sense, understand and share the feelings of another - because I was there.  

So to all my doula moms, thank you for the privilege of allowing me to witness your journey...

I was there when you believed you couldn't go any further but you did anyway. I was there when you felt your body would split itself apart but you kept it together. I was there when you found and accessed that primal power deep inside. I was there when you pushed past exhaustion. I was there when your hopes were shattered, when your deepest healing was won, when your darkest moments were met, and overcome. 

I saw what you did. 

Your triumph. Your power. Your vulnerability. Your pain. 

I saw it all.

And I want you to know: you are magnificent, you are fierce, you are breathtaking. 

I know because I was there, and I remember. 

Keep Calm and use your BRAIN!

This little acronym - BRAIN - is a powerful tool to increase your chances of getting evidence based care. So here goes - your care provider suggests a procedure, such as a stretch and sweep, or an induction, or even an internal exam at 38 weeks, or an episiotomy, or even a Cesarean birth - what do you do?

Sometimes medical decisions are based on outdated policy, financial or convenience factors rather than on what is best for mom and baby. Many parents are not sure how to question their care providers in a way that opens doors of communication rather than slamming them shut. The BRAIN acronym facilitates discussion in a non-threatening way.

What this really all boils down to is making sure that you are making informed choices and giving informed consent. This is a tricky field legally, and particularly in the area of labour and birth where there is a huge emotional component involved and families feel particularly vulnerable. 

Just remember, no one is allowed to do an internal exam or 'adjust' your cervix without your consent - if your care provider asks to do an internal exam and you give permission, and are informed afterwards that your cervix was manipulated or your membranes stripped - that is not informed consent and that is a violation of your patient autonomy. 

Furthermore, no one can inject you with anything or put anything in your drip, or cut into your flesh at any point without your informed consent - and if someone is busy doing something, an internal exam for example, and you say - STOP - you have withdrawn your consent and that person is required to stop what they are doing and withdraw their hand. 

You may be asked to sign a blanket consent when you are admitted to hospital (if you are birthing in hospital) - please read through it and discuss whatever you are concerned about. Perhaps you could get a copy before the time. It really is worth it! I have heard too many stories of women lying in bed for the duration of their labour because they believed that was just how it's done and didn't know they could request otherwise. Or women coerced into unnecessary inductions because of the doctor's leave schedule. For a first time mom, inducing labour drastically increases chances of having a Cesarean birth. If women truly knew the risks of the procedures they are apparently consenting to I think our phenomenally high Cesarean birth rate in our private hospitals would be a thing of the past.

There is much more I could say about this, but you get the idea. When in doubt, use your BRAIN!

Just so you know, I actually have a website dedicated to helping parents make informed choices along their birthing journey. Click here: http://www.giving-birth-naturally.net

When have you used the BRAIN acronym before? Please tell us!

Alternatively, was there a time you would have used the BRAIN acronym had you known about it? Tell us your story!

For Love or Money?

Is this doula worth the moola?

Find it here.

So as I'm nearing the end of this doula course I'm contemplating the possibility that I get to earn money doing what I love. That is a very privileged place to be!

High School teaching, ballet teaching, lecturing Art History at three different institutions, importing amber teething necklaces and hazel necklaces - I enjoy all of these things. But, with ballet teaching for instance, I never started my own studio because something in me just knew that as much as I love dancing and teaching, it's not what really gets me up in the morning. If I did force it just because it was what I'd always done, I think it would have eaten me alive.

Working with bellies, birth and babies on the other hand... Now this stuff keeps me up at night! I will sit and read journal articles on the benefits of one birth position over another for hours, or sit with a mom while she labours for as long as it takes and feel more alive at the end of it than I did at the start.

But I read someone the other day writing about how she found a doula who 'isn't in it for the money, but does it from her heart' and while I understand her point, I get a bit frustrated that it's seen perceived as an either/or situation - you do it for the money OR out of your heart...

I'd love to be be able to offer my doula services for free, all day and every day. 

I'd love to be be able to offer my doula services for free, all day and every day. But when I am helping a mom in labour, I need someone to help look after my girls, and that sometimes costs money (or bribes). I want to do extra courses in hypnobirthing and aromatherapy and massage and breastfeeding (and and and) to be able to help my moms even more - but they all cost money and take time.

Furthermore, being a doula can be really inconvenient! For instance, I have a glass of wine with dinner sometimes, but when I'm expecting a mom to go into labour I won't drink at all, because I am quite sensitive to alcohol and I don't want my driving to be compromised and I think it's disrespectful to pitch up smelling like you've been drinking.

I can't organise holidays or travel too far away when I'm expecting a birth soon - or vice versa, I can't take clients due two weeks on either side of a holiday. If you think it's tough not knowing when you're going into labour, I have the buildup every time I have a birth! Don't get me wrong, I'm not complaining, I just think people need to know.

So I am in the situation where I will need to charge precisely because I love what I do. And you know what, I think that my time and skills, and my heart, are worth it.

Get the T-shirt here.

The stats back me up and the moms that I've already helped would agree, continuous care in labour makes a big difference! But, on the other hand, I do believe that every woman deserves a doula and I'm not saying that I won't ever take clients who can't pay, and I most certainly will do volunteer work as well, but in order to have the space and the finance to do that, I need to charge those who can pay for the service.

Perhaps I could offer discounted services for special cases, or barter my services for car repairs, or set aside a small amount per birth to put towards moms who aren't able to pay the full fee; I'm not sure, I'll have to see how it goes!

So what can you do to make doula care more accessible? If your medical aid doesn't already pay towards doulas (Fedhealth and Momentum do, and Discovery should be signing up soon) then write a letter to them saying why they should pay for doulas! If they do, write and thank them and let them know how much you valued your doula! We, the doulas and midwives, don't have as much clout as you do when it comes to getting medical aids to pay up...

If your hospital doesn't allow doulas as an additional birth partner, find one that does and give birth there and write to the original hospital and tell them why you aren't giving birth there. Or have a home birth and have as many doulas as you like...

Hospitals are very precious about their maternity wards as in the bigger cities women have a choice as to which hospital they want to birth at, and maternity wards bring in good money for hospitals, so if they are losing patients because they don't allow doulas, they would love to know about it! If they do allow doulas, write to them and thank them and let them know how much you appreciated your doula!

The same goes for medical aids that won't pay for home births and hospitals that won't allow private midwives. You as the paying client have the power to make a difference in these institutions!

Was your doula worth the moola? Comment and tell us about it!
Have your writtena  letter to your medical aid or your local hospital? Are you going to? Let us know!

Who's your midwife?

So who is your midwife?

Normalizing natural birth...

We seem to have reached a place in obstetric care where interventions, even unnecessary interventions, are so normal that they aren't even noticed. Here in South Africa, most middle to upper-class women automatically hire a gynae (pronounced guy-knee aka OB-GYN) to deliver their babies. For me, that felt like calling a paramedic when I have a cough. 

In private hospitals here, the midwives employed by the hospitals actually get into trouble if they deliver the baby as then the gynae can't collect his full fee, but they also get into trouble if they call the gynae too early, because he (sometimes she) has a busy practice to run. And they need those busy practices because of the incredible insurance they have to pay.

I digress...

Within the last week I attended two screenings of the documentary Freedom for Birth (trailer above) which is about how women's rights are being violated in childbirth  - among a host of other issues related to birth. While I will be addressing this issue again, it really struck me how natural birth needs to be re-normalized.

I am always trying to encourage women to find a caregiver who trusts that a woman's body is designed to give birth, not someone who sees a pregnant women as a emergency waiting to happen. So I chose to have a private midwife in PMB, Arlen Ege, attend the birth of my second daughter at home. When I had my daughter, she was allowed to deliver babies at the local Mediclinic, but has since received notice that this would no longer be allowed. UPDATE: Sr Arlen Ege is once again able to do water births at Mediclinic in Pietermaritzburg as they have installed an outlet pipe for her birth pool! I was able to attend the birth at which this pipe was first used, also the first birth in a while in which a doula was allowed at Mediclinic - It was a beautiful VBAC in December 2013 - Birth Story to follow! 

Why I have to be a midwife...

But, how do we normalize natural birth? How do we help women to see that over 80% of them should be able to give birth naturally, when the current caesarean rate in our private hospitals is over 70%? Because when the number of caesarean births gets too high, they actually start causing more harm than they prevent...

Which brings me to my little revelation... In the city in which I live, Durban, with a population of 3.5 million, there are two practicing private midwives that I know of. If I am mistaken, please correct me, but even if there were 10, or even 50, that would still be too few.

How do we change the tide and restore midwifery care as the norm rather than the exception?

Well, what I've decided to do as my first step, is that whenever I get into a conversation with a pregnant lady, 'Who is your gynae?' will not be one of my opening questions as it usually is among my peers. My first question will be 'Who is your midwife?', and after that perhaps 'Have you found a doula yet?' You get the idea.

Language is such a powerful thing. Doctors use it all the time when they play the big baby card, or the 'but-your-vagina-will-never-be-the-same' card, or the 'If-you-were-my-wife-I'd-recommend-a-caesarean' card. What are you going to do to help normalize natural birth?