Durban Doula's Pregnancy Diary - Week 14

What another one?

No, not another baby, another blog post... I know I said I was going to do one every month, but there is just too much to write, so I'll try one every two weeks and see how it goes.

Our first appointment

So I saw our midwife, Arlen, this week - and I honestly can say I'm so glad I chose this model of care. Our initial appointment was just under an hour long, we talked about the pregnancy so far, how I had recovered from the last birth, what plans were for this birth and various other bits about birthiness in general. We checked all the vitals - peestick, weight, blood pressure and belly - and heard a little heartbeat too. It was great. It felt like home. 

I also got my home birth shopping list, and contract and prices for various birthing options, and like last time, the amount I'm paying for a home birth is still less than the co-payment I would have to make for a gynae in private practice on an average hospital plan that pays 150% of medical aid rates - as many gynaes charge over 300% of medical aid rates. I can understand why, given all the insurance that needs to be paid, but that's a topic for another time. Medical aids or hospital plans on the other hand, only pay 25-35% of the cost of a home birth - R2500-R4000 of R8000-R12000, even though I'd be saving them over 30k... Patriarchal prejudiced misogynistic mumble mumble mutter mutter...

And, as much as I have reservations about the safety of non-medically required ultrasound scans, (see last diary here), I admit I am a little excited for the one we are have in about 6 weeks' time. I think we'll take the girls (4 & 6) along with us, as they seem to be more excited about this baby than anyone!

Having said that, everyone seems so excited about this baby, which is so lovely for a third child! I'm enjoying being pregnant, because I know this will probably be the last time, so even getting past the nausea was bittersweet, as crazy as that sounds!

Obligatory Fresh Produce Comparison 

You thought I had forgotten about the obligatory pregnancy diary fresh produce comparison! Porridge brain has not set in quite so severely as that...

Well, baby is now about 8cm long (crown to rump) - about the size of a lemon. He/she is growing hair, can make facial expressions, suck his or her thumb, and can even pee. Yes, baby pees in the amniotic fluid, it gets absorbed by my body and gets processed by my kidneys so I can pee it out 53 1/2 times a day. At least it's easier than nappy changes!

Irritable Uterus and the Doula Pregnancy Protocol

Peesticks, irritable uteri and
getting rid of baby pee -
Toilets are an integral part of pregnancy
Wikimedia Commons

I am currently on call for possibly my last two clients before my own baby arrives, unless I get some clients for November and December. (Any takers? Last chance! Only taking one per month!)

I'm not sure what the protocol is on doulas and maternity leave, but I feel that January is a good time for me to stop, as I'll be entering my third trimester and may not have the energy for the physical demands of doula work - staying up all night, massaging for sometimes hours on end - it can get quite demanding, and by then I think my belly may be getting a bit large to be getting in anyone's space!

I have also experienced 'irritable uterus' with my last two pregnancies - yes, that is a thing!
I can already feel reasonably strong Braxton-Hicks contractions - tightening of the uterus without downward pressure, considered to be toning up for the real thing - as I did with my first two. I haven't ever had problems with prematurity, but it was uncomfortable having strong, and sometimes even painful contractions caused by over exertion, dehydration, a full bladder, an empty bladder, touching my belly,or sometimes seemingly caused by nothing at all. 

Plant Nanny - Available on Apple,
Android and Windows devices

I'm being more diligent with making sure I get enough magnesium and drinking enough water this time around, and I'm hoping that will help, but I thinking booking clients for my third trimester would still be unwise, for me and for them!

By the by, I'm using a little app called Plant Nanny to help me remember to drink water, and it seems to be working!

After the birth I think I'll need to take about a year's break from taking on doula clients, perhaps more depending on the personality of this little sproglet. I may still be able to do some volunteer work as that usually involves a set period of time, primarily in daylight hours. Again, this is one of those bittersweet things, letting go of something I love so much for a season, but that's just what it is, a season. Ideally I'd love to be a private midwife one day, so it makes sense to have my own children sooner rather than later.

As much as I will miss doula work, I am so looking forward to newborn snuggles! I went to help a friend with breastfeeding her newborn this last week, and those teeny tiny fingers and toes always undo me!

Other birthy things I'm thinking of right now... 

• Trying to think of how to fit three car seats in our Daihatsu Sirion
• Sorting out the girls' playroom and unpacking all of the boxes of oddments from when we moved so it's not stressing me out when baby comes
• Getting some newborn sized cloth nappies - a luxury I didn't have with my first two - I just started them off on regular cloth nappies and they spent their first few weeks with butternut shaped bums!
• Realizing how many safety gates we will need for our new house (at least 3!)

One last funny thing... Even as a doula and a third time mom who had great natural births with the first two, I do still have moments of consternation centered on the question, 'This baby is coming out where?'

So I pull a doula move on myself every now and then: Women all over the world do this all the time. Our bodies are designed to give birth, and so on.

I won't be quite so glib in my encouragement in future

After seeing how much I just wrote, I think once every two weeks might be doable - not as much pressure as a weekly diary, and not as much marathon reading as a monthly one - what do you think?

If you do want to get notifications of blog posts and pregnancy diary entries in your email, please subscribe by entering your email address in the box on the right, or follow me on Twitter on @DurbanDoula

And if you have any questions about how this Durban Doula does pregnancy, ask away below and I'll address them in future posts. 

Find Week 16's diary here and week 12 here.

Just 'cos he looked at your cookie...

'Just 'cos he looked at your cookie doesn't mean he's the one!'

I wish I had actually said that out loud. 

A pregnant mom was telling me about how she was considering a midwife-assisted birth but was leaning towards staying with her gynae, even though she knew his shocking C-section stats, because, you know, he had done her pap smears for the last 7 years. 

What is it with us that we don't want to disappoint people? We don't want our gynaes to feel rejected? Is that it? Because really, I don't think it's mutual. 

That a woman will stick with a gynae she is unsure of, because he has poked around 'down there' a bit, because he wrote a script for some Clomid, because he did the job that she paid him to do, even though she knows his C-Section rate is over 80%, I can't understand.

Like every abused woman contemplating whether or not she should leave, she believes him when he says, 'Natural birth is Plan A,' (even though the numbers say otherwise) and she believes that this time it will be different. 'I'm not like those other girls,' she says. 

I love gynaes, I really do. I especially love it when they do what they are good at - and it's not a stretch of the imagination to think they also enjoy doing what they are good at. What they are good at is dealing with situations when something is not quite as it should be, where there is a problem, or an emergency, or a real risk. To be honest, they are not trained to deal with plain old physiology. It is unfair to expect them to recognise it.

Like the teller at the bank who can recognise a counterfeit because of years of experience with authentic bank notes, so a provider with experience in physiology can recognise a problem before it becomes a problem.

Everything looks like a nail...

If you want surgery, you hire a surgeon. 

Otherwise, find someone who understands the difference between dealing with disease or trauma and supporting a physiological function.

Everything looks like a nail if you have a hammer in your hand.

But this is not the point I want to make. Where should your loyalty lie? With your care provider? I'm not so sure. Like I said, I'm not convinced the feeling is always mutual. You are one of many. In short:

The axe forgets, the trees remembers.

Should it lie with your family, your community, society at large? Again, I'm not so sure. Will they have to deal with the fallout of any problems? Probably not as acutely as you would have to. As the parent/s, you alone are held accountable in the end. If you leave the decisions up to others without knowing the facts for yourself, you are not making a free choice, but you will have to deal with the consequences of that choice.

This may come as a shock to many, but primarily you need to be loyal to your baby, and yourself. You, plural, are the priority here. A doctor's busy schedule or fear of litigation, or your mother-in-law's fear issues, the friend who referred you to that doctor to start with, the fact that the gynae saw your vagina already so what the hell - these do not deserve your loyalty. 

What is best for you, the motherbaby unit? Are you being treated as an individual or a number? A person or a potential litigator? An rational being or an irritation? Are you a participant or a patient?

Do whatever it takes to find someone who will treat you as a person, an autonomous individual capable of making good decisions. Someone who will give you all the relevant information - the pros and cons of every procedure, who takes your concerns seriously and is not threatened when you volunteer information that may be contrary to the current suggestion. Are your fears treated flippantly and your desires with disdain?  It is never too late to change providers.

If you need a second opinion, get one. Don't stall for fear of offending.

Do what it takes to get the options and opportunities that you and your family deserve. 

Whatever you do, remember that just because he looked at your cookie, it doesn't mean he's the one!

(In case you thought I was totally anti-gynae, I have some thoughts to share in an upcoming post. In short, I sometimes think our gynaes and obstetric nurses are the most disempowered of all...)

But until then, How did you find your care provider for your birth? Were you happy? Would you rather have changed? What advice would you give to moms who are having doubts about the person they've chosen to assist in the birth of their baby? Let us know below...

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