So the interesting thing about language is we often fall into the vernacular of our communities, intending to be understood, to show we belong and communicate in a way our community understands.
This is why I totally understand how doulas use some phrases without thinking.
Because if we take the time to think about it, some of the language that has developed among doulas is problematic.
I’m talking about doulas referring to clients as “my mamma”, or “my woman” or any of these variations. “I have a woman in labour… My woman is at x hospital… I have a labourer …”
Women don’t belong to us. We can’t claim them.
As doulas working in an industry that strips women physically and metaphorically of their autonomy, we must be vigilant about the language we use. When a large part of our work is creating scaffolding around women, supporting them to maintain autonomy and agency, it makes no sense that we use language that is patriarchal and paternalistic in nature.
Women’s bodies have been claimed over time by fathers, husbands, churches, governments and doctors. Let’s not add ourselves to this list.
Please be mindful of how you discuss women in your care. If you are debriefing or talking about clients and trying to maintain anonymity (so not calling them by name) try out a few phrases that you might use instead.
Are you a doula interested in exploring the intricacies of the maternity system? Do you find yourself examining women’s care, the maternity system and (often lacking) maternity choices?
‘Women, the system and the illusion of choice’ is available exclusively to doulas undertaking We Birth’s Mentorship Pilot Program, in addition to 1 to 1 mentorship and an absolute cornucopia of advanced doula education.
Enrollments close August 20. For Australian doulas only.
Jane Hardwicke-Collings & Sheryl Sidery share insights into how the current maternity system fails to support women’s choices and protect women from morbidity. When women are able to use their voice and be at the centre of their care.
So the phone rings, or you receive an email with the details of a potential client. The conversation goes back and forth and after a while, she says she would love to meet you. Yay. You make a time to meet her and her partner at their home. Probably one evening after they finish work. So do you know what you are walking into?
Apart from the obvious risks for anyone walking into ANY unknown home with unknown people, as a doula, you are not just entering peoples homes but embarking on conversations that can turn very personal very quickly.
Family dynamics are so unique and often have a private face in addition to their public one. With the old adage “We don’t know what goes on behind closed doors” it is no surprise then that we what we see is not always what we get.
Victoria, Australia has been averaging anywhere between 6,00 -8,000 Reported cases of family violence per year.
We know that these cases are underreported.
Pregnancy is often a time violence begins or increases.
So walking into a happy family home may not be so happy. How can we protect ourselves?
And violence is really only one aspect of assessing risk.
What about Alcohol and other drug use? including smoking? Are you happy to step into these environments?
And then there are less nefarious issues of personal safety. Are they renovating? Any environmental hazards that like construction, stairs, or is access in the dark difficult?
You might even think about parking, meters and timing?
These are the sorts of questions some doulas are probably already asking, and others maybe later. I used to ask a few of these questions once I met with clients (particularly the parking question) as a lead up to the birth but later realised that I was regularly venturing out to unknown palaces with unknown people AND often was the only person who knew where I was going and for how long….
If you trip into a ditch on their property and hurt your foot, could this affect your ability to work? Is your income protected?
If you get a parking fine after attending a meet and greet have you just taken a big bite out of your profit?
What are the additional unforeseen emotional and financial costs to taking this job and is this the right thing for you?
Systems and procedure can be boring and cumbersome. However if doing a simple “risk assessment”, by asking a few questions can prevent any harm to you it might be a good idea to add this to your regular routine. The other benefit routinely conducting a risk assessment is that clients are less likely to feel singled out. Some of the questions might seem really forward however when you are explaining why you ask them most clients are very understanding.
As most doulas are working independently it is important to take the time to protect yourself when no one else can.
Ask questions. About everything. Literally everything. “What are you doing? Why are you doing that? What other options do I have? Are there any risks with doing that? What else can you do instead?” Ask questions about where you birth, when and with whom. Ask what the evidence is and if there is any contradicting it. Learn about levels of evidence and recommendations in pregnancy. Know your hospital’s policies on induction, monitoring, appointments, home visits, breastfeeding and bottle-feeding, support people, bed sharing, everything. Read every one. And learn the difference between policy and evidence.
Birth at home. On your turf. This is probably the closest you will come to completely disrupting the system. When you invite your midwife in, it is in your space, according to your rules.
Say no. Without justification or explanation. (You know, there is no legal requirement for you to give a good enough reason for refusing something?)
Be difficult. Don’t sit down, stand up. Let them sit. You have the power, you take the higher ground. Tell them to wait when they knock on the door, and if they come in unannounced send them out again. Reclaim your space and your privacy. This is your body and you choose who sees it. Be that “bad patient” the one who takes their time, who waits until they are completely sure to make a decision. If your appointment isn’t long enough ask for another one. If that’s not enough ask for another.
Move beyond the binary thinking. It isn’t public v private, midwife v doctor, home v hospital, vaginal v. cesarian. There are a million different possible ways your birth can go. I guarantee there is always a third option. It is possible no one has thought of it yet. It is NOT possible you only have 2 options. This kind of thinking makes people very easy to control. Tailor your care to your needs. Be in the centre of every decision. All of you. Not just your uterus and the life it contains, but your hopes, dreams & identity including spirit and emotions.
Prioritise your needs above your baby. You matter. You matter because you are a person in this world and your experience and decisions matter. You matter just because of you. It is also good to know that no one in this world will love and care for your baby more than you will. So make sure you are ok, because if you are ok you can make sure your baby is too.
Make decisions based on your feelings. The maternity system is obsessed with data. There is a risk for everything, Every choice has a number. And sometimes those numbers are really important. and sometimes they are arbitrary. It is ok to make a decision or not make a decision based on how you feel. This is just another kind of knowledge.
Never ever ever start a sentence with “Am I allowed to…?”. Try “I want to”. Or even “I am going to”.
Know your power. learn your rights. Get a doula. Collect the people around you that hold you up. Don’t allow anyone in your space that keeps you small. That is your mental space as well as your physical space. You are so powerful. You have not just created but also gestated a baby inside you. Your body is amazing. Don’t let anyone make you feel anything less.
Change your mind. If it feels like things are spiralling out of control or even gently heading in a direction you don’t feel comfortable with and you want to get off the train. Get off. Shut it down. Try something else. You DON’T have to do anything just because you said you would. You have no obligations to anyone but yourself. And I mean only yourself. Not you and your baby (see 6). Change your mind whenever you damn feel about it.
It is crazy, but current obstetric practices are actually increasing the chances of causing fetal hypoxia and possible MAS or Meconium Aspiration Syndrome.
On Jan 14, 2015, Rachel Reed posted “The Curse of Meconium Stained Liquor” in Midwife Thinking. Rachel says that it is not meconium alone which is a problem, but meconium plus an asphyxiated baby that can create the possibility of MAS which may result in infection and also death in some babies.
So, is it that obstetric practice is out of date?
We are still:
Directing pushing to speed up labour,
Performing artificial membrane rupture (ARM) to see if there is meconium present
It seems that we appear to be fear driven and acting upon the presence of meconium alone without considering the risks of fetal hypoxia which is linked to all of the above as stated by Rachel.
What should we be doing instead? It would seem that monitoring the baby would be essential looking out for signs of distress. Then of course act and make decisions on those babies with thick mec and showing fetal distress.
However, like Rachel suggests, we should be creating a calm environment so the mother is not frightened and we should be avoiding all obstetric interventions associated with fetal distress.
This is yet another highly positive reason to have a doula at birth ensuring the calm relaxed atmosphere that is necessary when meconium is present.
Coming soon… Emergencies in childbearing for doulas and birth workers course. Be the first to know when this course is available by registering your email addresshere.
“Natural caesarean section” is a term coined around a decade ago in an article called The natural caesarian: a woman-centred technique written by Smith, Plaat & Fisk (midwife, director of women’s and children’s services, anaesthetist and surgeon respectively) and published in the British journal of gynaecology.
This paper created chatter, which continues till today, where more and more often we see pictures and film, hear words of encouragement and praise, all so excited to see positive change in how women and their babies are cared for during caesarean births.
The original article/ designers marked an acknowledgement in obstetric circles that c/section, for many women, is not an experience they find “satisfactory” (this is possibly the most beige way I have heard women’s negative experiences of surgical birth described). Although there is no mention of the increased risk of death, haemorrhage, infection or any other complications, this article does focus on women post-caesarean being more likely to experience postnatal depression, bonding with their baby and breastfeeding.
And behold they found the answer:
“To improve the experience of women having uncomplicated caesareans, we have modified obstetric, midwifery and anaesthetic practice over the past 6 years to emulate as closely as practicable the woman-centred aspects of ‘natural’ vaginal birth.”
This needs to be unpacked.
What is an uncomplicated caesarean? I assume it is a planned caesarean, one where the baby is expected to be born in a reasonable condition.
How have the practices been modified? There is a bit of variance depending on where this is practised however you can find a good description here.
Having a baby born this way, slowly, with delayed cord clamping, skin to skin and free to breastfeed if wanting to. Where possible there is the woman’s choice of music, (somewhat) dimmed lights, midwifery support and partner in attendance. It is about time. With about a third of babies in Australia being born by caesarean section it has been a long time coming that we are finally listening to women who are deserving of so much more.
I have been present in theatres where women, stripped naked, alone and terrified are paralysed and ignored in the centre of a brightly lit room, where a room full of staff carrying out their preparations take the time to talk, laugh and joke, in a way that would not be out of place at any office. But this is not an office. This is a child’s birth. And this mother is an incidental element in the morning’s schedule.
So I am genuinely relieved to see this positive shift towards respectful births for women undergoing a caesarean section.
But there is nothing natural about it.
Can we call it respectful caesarean? I feel like calling it natural, in 2017, the era of kale chips and green smoothies connotes a sense of wholesomeness and implies an organic ideal. We really need to be clear, this (caesarean birth) is a completely contrived situation, albeit one that is completely necessary, acceptable and even desirable when it is used to save the lives of women and babies.
I also question how women-centred it is. I accept women want their babies close, and being supported to have a skin-to-skin contact at birth is a step in the right direction. I would argue that many of the other ‘steps’ in this style caesarean are baby focused more than women-focused.
I understand the development of this technique took 6 years, however, it is unclear how they came to choose these particular interventions? Were consumers being consulted in any formal way? Anecdotally there HAVE been stories of women describing an intense desire to be the first to touch their baby. This certainly can’t be discounted.
There are other areas that could be looked at to improve the woman-centredness of it all. Allowing doulas in the room, no separation between mother and baby in recovery, continuity of midwifery support, one to one midwifery care postnatally, antenatal expressing of colostrum to reduce delay in milk production. Are women given these options? Or are they offered only the interventions acceptable to the institutions performing caesarean sections?
We are also still lacking data that confirms these changes are making any difference to breastfeeding, maternal satisfaction, bonding and postnatal depression.
I am not the first person to recognise that most of the time when we discuss “risks” associated with birth it is the baby who is central to the discussion. Although the background risk for any woman, even a healthy, young one, to be seriously injured from birth is much much higher for women birthing via caesarean section (compared to vaginal birth) we tend to hear almost exclusively about the benefits and risks for infants.
I am concerned that as this kind of caesarean birth is glorified some advocates might forget to mention that this is actually a risky procedure. For women, they are 3x more likely to die from caesarean section than vaginal birth. This statistic is the same regardless of the lighting*.
For those who might benefit from more women birthing via caesarean here is a now a way to package and promote caesarean as the new and improved vaginal births. Just with better vaginas.
Dr Gerry Burke, Consultant Obstetrician/Gynaecologist and Clinical Director, Maternal and Child Health Directorate, UL Hospitals Group, stated that the gentle Caesarean represented “another small step in the evolution of this most ‘normal’ of all the surgical procedures”.
Unpack that. And tell me all the ways a cut in the belly is normal.
And then answer me, where does this evolution end?
*Actually I have no idea if the lighting affects the stats of maternal mortality. This is hyperbole gentle readers.
The problem I find most about being somewhat introverted is that I can’t abide small talk. I am sure this is what suits me well to the world of birthing and women’s spaces. I tend to dive in and talk with people about the more intimate experiences in their life.
So spending a morning with independent midwife Sheryl Sidery and Women’s Mysteries Teacher Jane Hardwicke Collings (in truth these descriptions barely touch the surface of who these mighty women are and all that they do), discussing birth, our maternity system, women’s choices and power struggles was my idea of a perfect day.
Of course, these conversations are important and best shared around. Fortunately, Jacki and I were prepared and managed to film some important and powerful dialogue that we can’t wait to share in our upcoming course: Women, the system and choice the illusion of choice.
If you are not yet on our email list now is the time to add your details and be the first to know when this is course is available.
In the meanwhile, we have put together the sneakiest of peeks for you to get a glance at what we are creating. drop by HERE
I am a member of a lot of mum’s groups on Facebook. Some offer information, some support others a sense of community. And sadly, almost every day a mum, somewhere is posting, pleading for help/support/acknowledgement as she struggles, feeling overwhelmed and drowning in motherhood.
There tend to be 3 main camps of response.
Place some measure of separation between you and your baby. This plays out in numerous ways but what they all boil down to is this: the idea that a mother and her child as a dyad, is essentially a broken and imperfect organism.
Do nothing: Of course, this isn’t what is said. Instead what is offered is well-meaning commiseration, empathetic and caring replies. Usually, this camp tries to give a reasoned response why what is happening is biologically or developmentally normal. To their credit, a lot of this is usually true. And I have definitely spent my share of hours being the miserable know-it-all sadly “helping” another mum by explaining that unfortunately the exhaustion she is experiencing is normal, and yes she is isolated and overwhelmed, however, her baby is healthy, growing well and acting exactly as a baby of that age should.
Practical help. This is above all the best but unfortunately the least common, and most difficult to sustain. I have seen women drive hundreds of kilometres to help another mum they have only ever met on line, meal trans organised, breast milk drives, expressed, stored, rounded up and transported to women for any number of medical and social needs. Funds raised for hospital trips, lactation consultants, specialist appointments. I have seen women open their homes and hearts and they opt in to co-parent and cooperate to help other mums wherever they are.
So why am I confounded?
I am blown away that we, as women, mothers and maternity workers are not more enraged. That we have quietly and without too much fuss accepted that motherhood is clearly not valued.
I am blown away that we, as women, mothers and maternity workers are not more enraged
In Australia over 300,000 babies are born each year. That is a lot of mums and babies. Women as consumers are an incredible force. So why aren’t we demanding more?
Why is it a mum needs to crowdsource the fees to pay a lactation consultant?
Why is it that lactation consultants are not able to access Medicare rebates?
Why are there so few mental health services for women and babies? There are 12 private beds for women with private insurance in NSW that allow their baby to stay. Publicly there are 2 that I know of. (feel free to comment if you know more). These beds are usually for women experiencing severe depression and psychosis.
And for women who are struggling with the transition to motherhood, depressed, anxious and somehow managing to keep afloat. What help is there for them?
Forget about financial support.
18 weeks paid parental leave. But to be eligible for this there are working requirements. So get back to work quickly if you plan on having another child soon. But your income is mostly spent on daycare costs. So good luck feeling like it is worth your time.
And what is with this propaganda saying paid government leave and paid maternity leave from an employer is too damn much? Greedy women. If a woman is fortunate to work for someone who actually values paid maternity leave this plus government support is somehow taking advantage of a (shitty and broken) system. Who cares if it enables her a few more months to focus on her baby?
And can we talk about the gas lighting that is going on when we tell women that breastfeeding is optimal, for at least 6 months exclusively, but only affords them to take off about 4 months from work? So now she can feel inadequate when she is separated from her baby and predictably encounters breastfeeding issues (which again, a visit from a lactation consultant might help but who is paying for that?).
And partners get a whole 2 weeks paid leave (at minimal wage).
There are so many broken parts to our public health system, These examples are just a taste. It all starts around birth where women are overstuffed into large maternity hospitals and spat out into the world to navigate the world of GP’s, child and family health clinics, and if they can afford it, paediatricians.
“I have a sneaking suspicion we are not supposed to acknowledge that this is a fundamental shift in identity. That we are supposed to take a few months off to ‘recover’ and before we are ready, hide any sign of stretch marks with an expensive cream and get back to business as usual.”
But where is all the support, and information about you know, becoming a mother? (I have a sneaking suspicion we are not supposed to acknowledge that this is a fundamental shift in identity. That we are supposed to take a few months off to ‘recover’ and before we are ready, hide any sign of stretch marks with an expensive cream and get back to business as usual.)
If a mum is lucky she will receive a couple of home visits from her midwife in the first week. I promise you it is not enough. it is not nearly enough. And having spent time on the other side I promise your midwife wants to spend more time with you too. We know you deserve more and are so sorry this is all we can give you.
SO WHY ARE WE ALL SITTING BACK AND ACCEPTING THIS?
THIS IS NOT ENOUGH.
Because motherhood is valuable.
Because a mum and her baby are supposed to be together. (as in it is biologically normal -not that there should be any societal pressure that a woman MUST be inseparable from her baby)
And babies are hard work. It can be tricky to adjust to life for them and us, They don’t sleep like adults (and this is normal and healthy).
And community support is commendable and beautiful but limited.
And we, women and mothers, are a powerful cohort of consumers that really need to speak up and say we have had enough of this absolute mockery of a maternity system.
My name is Jennifer Hazi, I am a Registered Midwife, Doula and childbirth educator. I work as a midwife in a busy suburban hospital in Sydney, privately with women and their families in their homes and facilitate a monthly space for pregnant women and their female support people which is a unique mix of education, connection and space for women to process the changes and expectations where they are in pregnancy.
I fell in love with birth sometime during my first pregnancy in 2005. Over the course of my pregnancy, the fear I didn’t even know I had was slowly educated away and a fascination with the body’s ability to grow, birth and nurture a baby with very little help from outside.
I began my work as a doula, training with an experienced doula in a mentor/mentee relationship. After a year of working together under the nurturing eye of an experienced doula, and completing the Optimum Birth training for good measure, the launch into private practice was smooth and joyous.
My hunger for all things parturition continued into my direct entry Bachelor of Midwifery at UTS. While studying I juggled childbirth education, working as a doula and my growing family. I am fortunate to have worked with women in continuity not just through one pregnancy but over the course of their childbearing career and being invited into such an intimate and incredibly life-affirming space with new families is a continual privilege.
I now have 5 witty and vivacious girls who keep me busy and work clinically as a midwife in a large tertiary referral hospital in Sydney. I absolutely love working as an educator and working with women and their families as they discover their own fears about birth are dissolved with good information, a space to reflect and time. I work privately with women and families wherever suits them antenatally, and postnatally in their home. Occasionally I attend births as a doula, however, at this stage, I try to “pay it forward” and bring a newly qualified or student doula with me. I have begun to play with photography and filmmaking more to fulfil my creative needs (far from professional!!), and my only regret is I didn’t start sooner.
So what are my passions? My family is number 1. Having 5 daughters definitely gets me thinking more than ever about women, our empowerment and how to ensure the road is smoother for the next generation. I am fortunate to have found a profession which is also my hobby. I know many of you feel the same way. I truly believe doulas are an underused resource for women and their families in both the birth space and the postnatal period. I know for myself what a pleasure it is to work with compassionate and caring doulas and how much physical and emotional support in the postpartum can have such a positive effect years later.
I really believe we, as midwives, doulas, obstetricians, childbirth educators, birth photographers, postnatal support people, birth workers and all of us in the perinatal space have a massive responsibility to protect the future by providing care in the most respectful and uplifting way possible.
Words: Jen Hazi
(It’s pretty difficult finding a non-pregnant pic of me but I did it.)