Advanced Doula Workshop in Portugal
Alex and I connected for the first time around nine years ago and the reason we connected was around birth and midwifery. We are not quite sure where and when it was that we first heard of one another but I do remember hearing via various whispered sources about this brave young French woman who was living very simply on a very isolated farm in the Eastern Cape, South Africa, and who had chosen to give give birth unassisted to her first baby. (You can read the story of Alex’s second birth, also a free birth, outdoors in the Eastern Cape, here). Alex and I first chatted online. I was pregnant with my third child. We discussed our births and shared our dreams of one day becoming midwives. Alex was the first person to ever tell me about Lotus Birth and highly recommended I try this for my next birth. I imagined birthing in a room filled with scented flowers, visualising myself opening like a flower for the sun to birth my baby. I have to admit, I was slightly disappointed to find out that all a Lotus Birth required was not cutting the cord of the baby and waiting the 5-7 days for the cord to naturally fall off. Alex, along with her husband Yan, and their good friend Ole, pioneered the intentional community Khula Dhamma, initially founded on Vipassana principles. Over the years, our families met regularly, both in Cape Town and at Khula Dhamma and needless to say, Alex and my conversation would steer towards birth and midwifery. We shared our stories and experiences and always, we strongly resonated regarding birth and our implicit trust in women’s abilities to unlock (when given the opportunity) something deep and powerful within themselves. Four years ago, Alex and her family left South Africa and lived in Brazil for two years before finally settling in Portugal. Alex has been inviting me to come and visit for a long time and when she heard I was going to teach in Spain she invited me to come and teach some of the doulas in her area too. So after my ten-day teaching stint at De-a-luz in Spain, I traveled on three busses to the Algarve in Portugal. So this last weekend, doulas from Portugal came and we discussed mostly our experience of birth(amazing how birth-y people never seem to tire of this subject!), spoke about creating the optimal environment for a a fetus ejection reflex and physiological birth, and learned some skills around resuscitating babies as well as some basic but essential obstetric emergency skills. The question was asked as to why these would be skills a doula should learn since a doula’s role is to provide non-medical support to the mother. The answer is quite simple: The World Health Organisation states that one million babies die each year from birth asphyxia (an inability to breathe at birth) and recommends that every birth have an attendant skilled in neonatal resuscitation. If you are attending births regularly, you may find yourself in a situation where a baby is not breathing, or where a mother is bleeding more than usual, or has a prolapsed cord…You may be alone with her, or you may be at a home birth with a midwife, or driving in a car, or even be in a hospital. You may be the only one who can deal with that situation right then and there before the mother and baby can be transported to hospital, or you may need to assist, or you may just need to support a mother and her family during...
Read MoreHelping Babies Breathe
Helping Babies Breathe (HBB) is an initiative of the American Academy of Paediatrics and the World Health Organisation. It is a programme that has been implemented to ensure that every birth attendant is skilled in the basics of neonatal resuscitation as part of one of the five 2015 Millennium Goals (to reduce infant mortality). Apparently, in Countries where this programme has been implemented, governments have found a decrease of up to 25% in neonatal deaths. Helping Babies Breathe is a neonatal resuscitation curriculum for resource-limited circumstances. It was developed on the premise that assessment at birth and simple newborn care are things that every baby deserves. The initial steps taught in HBB can save lives and give a much better start to many babies who struggle to breathe at birth. The focus is to meet the needs of every baby born. Helping Babies Breathe emphasises skilled attendants at birth, assessment of every baby, skin to skin contact with mother, delayed cord clamping, temperature support, stimulation to breathe, and assisted ventilation as needed, all within “The Golden Minute” after birth. Midwife Marianne Littlejohn and myself are trained as teachers and trainers of HBB and volunteer for Operation Smile and have thus far taught midwives, doctors, NICU staff, nurses, doulas, birth attendants, mothers, fathers, and interested people these basic but life saving skills. We have been privileged to teach all over South Africa, as well as in Malawi and Kenya. Plans are also afoot for us to teach in the DRC and Lesotho, as well as continuing to teach in South Africa. This last week I taught the skills to a group of peers, WOMBS doulas and CPM Mandi Busson at friend and colleague Lana Petersen‘s home. I must admit to feeling slightly intimidated, teaching friends and colleagues but this fell away very quickly as stories were shared and we acted out various scenarios from precipitous unplanned home births to water births. What I love about the HBB programme is its emphasis on normal birth – that it reiterates that approximately 90% of all births are straightforward and that it teaches as its introduction how to facilitate that: Skin to skin, delayed cord clamping, breastfeeding, etc and that even when a baby needs help to breathe, that every step is take to ensure that that mother and baby bond and cycle is not broken. Here are some pictures from this week’s course. We had so much fun acting out the various scenarios that plans are afoot for some fun birth theatre sports, possibly to be presented at this year’s Cape Town Midwifery and Birth Conference. If you would like to host or attend a Helping Babies Breathe course, please contact...
Read MoreAre We Creating an Epidemic of High-Risk Women?
Two weeks ago I wrote about the first unnecessary caesar I attended. It was the first but it was also not the last. It did prompt me to do my homework and to really make sure that the women I was attending as a doula were well informed. One of the things I did was call up all the maternity wards of all the private hospitals here in Cape Town and ask them directly what their their caesarean section rates were. I knew from discussions with other doulas and midwives that many caesars were taking place but I did not have clear numbers. The conversations went something like this: “Hi…I am a doula supporting mothers wanting to birth vaginally in private hospitals here in Cape Town and I would just like to know what your caesarean rates are so that they can make an informed decision about where the best possible place to birth is.” Or something along those lines. Responses were everything from helpful and obliging to irritated, rude and irate: “Oh one doctor here has about a 60% caesar rate…he really tries, but the others are definitely around 80 – 90%” “About 65% but I think it is the private midwives that do deliveries here that bring the rates down…the doctors have much higher rates than that.” “Between 60 and 90%.” “I don’t see why we should divulge this sort of information, I don’t see how a high caesarean rate can make a difference to a woman’s chances to birth naturally!” “It is definitely upward of 80% but I am not telling you how much higher – I don’t think it is any of your business!” So in private hospitals in Cape Town, we are looking at a caesarean rate of 60 – 90%. And from my experience in two of the major government hospitals in Cape Town, it seems to be around 50% in the public sector. The World Health Organisation recommended a caesar rate of between 10 – 15% as being healthy, so WHY is our caesarean section rate so high? And why is it not my business to find out the caesarean rate of a hospital that is often promising to be supportive of women’s wishes to birth as they wished? And why is it suddenly okay to slice open perfectly healthy women and change their obstetric history forever? (I need to stress that I am not anti caesarean. I am eternally grateful for the operation that saves the lives of mothers and babies. I am not putting down this very necessary intervention and the skilled people who can perform it.) Since then I have worked within home birth midwifery practices and met midwives from all over the world who maintain a caesarean rate of between 2 and 20 %. Why do they get it right and the hospitals do not? I think the saddest and hardest thing for me is meeting the women who have undergone these unnecessary caesars. Who come with their stories. And who really want to give birth vaginally this time around, sometimes after one, sometimes after two, sometimes after more caesareans… I was induced at 38 weeks and didn’t progress so I had to have a caesar. The doctor said my baby was getting to big and I would never be able to birth her – but then she was an average size! I had a supportive doctor but she was on holiday when I went into labour and I got the doctor with the highest caesar rate in the hospital. The environment was too clinical for me, the beeping machines,...
Read More