ICAN Cowichan Valley on TV!

ICAN of the Cowichan Valley has been lucky enough to get some coverage on our local cable TV channel!  I make some stupid faces, and unfortunately, the parts about how to prevent c-sections and promote VBAC got cut in favour of my ridiculous comments about Ricki Lake (the interviewer asked the dreaded celebrity question and I got stumped, having prepared to talk about things that are much more “serious” and on point), but still…good publicity.  I should also point out that Haley, who speaks about her c-section after 24 hours of labour, had a VBAC with her second baby, seen in the clip (who is, not incidentally, totally adorable).

This comes at a good time, as we’re gearing up for some great events this fall.  Our September meeting will be an open topic support group, but we’re going to have some thematic action for the rest of 2011!  Each meeting will still have a support group component, with topics determined by the women in attendance.  But we’ve also got some amazing guest speakers lined up.  In October, Sarah Juliusson of Island Mother is going to speak about giving birth by cesarean again, to help participants transform a cesearean into a connected, and confident birth experience.  Our November meeting will be a birth plan workshop with Cindy Storie-Soth of Cowichan Childbirth, who will help women to articulate a vision for their birth that identifies their values and priorities, while being flexible and responsive to the unpredictability of any birth experience.  And we’ll end the year with a screening of The Business of Being Born, and a discussion of how the issues raised there apply (or don’t) to birthing women in Canada, as well as some brainstorming about how we can develop individual strategies to help improve the care we receive.

Lots more plans cooking for 2012, so stay tuned!

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First ICAN Cowichan Valley meeting: Success!

The first ICAN Cowichan Valley meeting took place at my house this past week, and my immediate response was why did it take me so long to get around to organizing this?!  I wish I’d done this 4 years ago, when I was postpartum with my daughter.  If you’re unfamiliar with what ICAN does, you can read their mission statement and more information here.  It’s critical to have an organization advocating for women, and supporting women who experience cesarean sections, and ICAN does incredible work in many different ways, both through its central office and local chapters all over the world.

The turnout for the Cowichan Valley meeting was better than I expected.  Out of respect for confidentiality, I’m not going to write anything about the women who came, but suffice it to say that there is a clear need for this group in our community.  It’s gratifying to feel like we’re doing something for one another in the immediate sense of offering face-to-face emotional support, information and resources.  More than that, it’s energizing to be taking concrete steps to make a bigger change:  to ensure that women have access to VBAC, to talk about how to make the c-sections that do happen more family-centred and woman- and baby-friendly, to strategize around how to talk with our care providers and ensure that we’re being heard, before c-sections happen as well as afterward.

These meetings are small steps, to be sure, but sometimes even the tiniest movement is meaningful.

Birth community and a little update

A while back I posted about wanting to generate a birth network here in the Cowichan Valley.  But the crazy few months that followed meant that that wish never got too much further than a blog post and a couple of discussions with friends.  So I was super excited when I was invited to join a circle of women at the new Matraea Centre in Duncan, called together by Sarah Juliusson of Island Mother, Dancing Star Birth, Birth Your Business, and other cool projects. Sarah took the initiative to bring a group of people whose work supports pregnant and birthing families for a Birthing from Within training for professionals and discussion about our local birth community. 

I was tired and rushed last night, and had had one of those days where it’s lucky I work mostly from home because other humans would not have appreciated my mood.  But I made it to Matraea nonetheless, and am so glad I did.  I already knew some of the women there including the midwives, and a postpartum doula (aka goddess) who founded the New Mom Centre, and I met some others whose services include pre and postnatal yoga, and prenatal dance and art.  It was amazing to be sitting in a room full of so much excitement–excitement about Matraea, excitement about building connections in this community, excitement about sharing a common enthusiasm for supporting women and families. 

It was exciting and also educational.  Sarah took us through an exercise designed to help us examine the way we listen and respond to women when they talk about pregnancy and birth.  We worked in pairs to practice not only reflective listening but also body language that shows our clients that we are ready to ‘meet them where they are.’  I took away the message that we need to really hear what women are saying, recognize the validity of their position, and work with them so that the choice they make is truly theirs and not an empty reflection of our values.  This process focuses not on the outcome–not on what a woman ultimately chooses to do–but on how she gets there.  Does she feel supported?  Does she feel confident?  Does she believe that she is the most important person in the equation?  Does she own her own pregnancy, birth, and body? 

Tomorrow I’m going to start going to one of Sarah’s Mama Renew groups.  I’m not sure I’ll be able to do the whole session; I may have a scheduling conflict, but I won’t know for a while.  So, in the meantime, I’m going and I’m really curious about what it’s going to be like.  I have pretty much no idea what to expect!  But I hear it’s an awesome group of women (8 or 10, I think), so I figure it can only be good. 

Tonight is the first ICAN meeting here at my house for the Cowichan Valley chapter.  I’m nervous, which is funny because there’s really nothing to be nervous about.  I’ve wanted to do this for such a long time, as I think a group like this can really make a huge difference in a woman’s life, if it’s there for her at the right moment.  So, even if no one comes, just spreading the word and waiting so that ICAN is available for any person who may need it at any point in the future is good enough.

Q: Why make such a big deal about birth? A: Feminism

People often ask why I invest so much energy in birth activism, and why I care so much about how women have babies.  After all, babies are born every minute of every day, all over the world.  Why make such a big deal about it?

I started caring about pregnancy and birth when I started linking it to my identification with feminism.  I’d always known about both:  for the duration of my childhood, my mother was a family doctor with a busy obstetrical practice, and she was (is) a feminist.  I don’t recall her linking the two explicitly, at least not to me.  (Although we did have a book about Judy Chicago’s Birth Project on our coffee table, and I understood without any doubt in the 1970s that the fact my mother was a doctor at all was because of this feminism thing that she and her friends sometimes discussed.)  But I knew from the time I could be conscious of anything that supporting pregnant and birthing women was worthwhile and that feminism, defined very simply as empowering women to do whatever we wanted to do, was good.

I got that birth mattered, and that women deserved to be treated with care and respect.  I remember little things like my mother’s answer when I asked why she had short nails without nail polish:  so she wouldn’t scratch her patients when she was delivering their babies.  That made deep sense to me as a child, illustrating in an utterly comprehensible and practical way the things we can all do to make women more comfortable when they are vulnerable and in need.

Birth mattered and it also seemed absolutely mundane, and often annoying.  I was not amused as a child by having trips to the park and the pool interrupted because my mother was on call and some lady was having a baby.  I did like making pictures with all the colourful tape at the nurse’s station in the hospital where I sometimes had to wait for my mother while she worked.  But I didn’t like having to wait. And sometimes I was impatient:  I once told her to “just do a c-section” when a patient seemed to be laboring for an awfully long time, interfering with whatever it was I wanted my mother to do for me.  Yeah.

It was all very matter of fact until after my first baby was born.  I realized then that birth might be common but it’s actually never mundane, and that all the care and respect that I received as a pregnant and laboring woman—that I took for granted from a family doctor who my mother had trained—was not necessarily the norm.  I learned after the fact that I was lucky to have grown up believing the things I believed about women and to have had the kind of birth I had, and that my total, unfailing trust in my doctor and my mother’s medical angle on birth might be worth questioning, even though they believed in the medicine they were practicing and my outcome was good.

My daughter’s birth almost fifteen years ago radically altered the way I understood women’s relationship with medical approaches to childbirth.  The high I felt after giving birth, the incomparable sense of accomplishment and power, was so incongruous set alongside my unquestioning willingness to let my doctor manage my pregnancy and to accept—even anticipate—interventions simply because they were ‘normal.’  I began a long process of reframing and rethinking, asking questions, demanding justifications, searching out evidence of benefits and risks, wondering what ‘normal’ even meant and why anyone automatically believed, in the context of intervening in pregnancy and birth, that it was good.

It didn’t take long for me to recognize that the framework for my analysis was feminism.  Feminist thinking made it possible for me to de-center medicalization without demonizing individual doctors, and to explore other approaches such as midwifery without romanticizing them.  Feminist thinking encouraged me to look at pregnancy and birth first from the perspective of the women who experience it, and consider the ways in which ‘normal’ pregnancy and birth are constructed by particular social, historical, political and economic contexts.  Feminist thinking made it impossible for me to look uncritically at any action that interfered with women realizing or being supported in realizing the unhindered potential of their bodies, and allowing their bodies to take up space, and be noisy, messy and inconvenient.

It probably comes as no surprise that this has all led to some *cough* interesting conversations between me and my mother.  We agree on the fundamentals:  birth is not a medical emergency, interventions should be kept to a minimum, and women deserve respect.  We agree on many critical points, including a shared sense that today’s skyrocketing caesarean rate is a problem and the importance of supporting all women in making truly informed decisions about their own reproductive health.  But then there are other topics, such as the relative safety and advisability of homebirth, where the discussion gets a little more complicated and I have to remind her:  intentionally or not, you raised me to think this way.

Believing in women’s bodies and their capacity to grow, birth and feed babies without undue intervention, and in women’s right to control their own reproductive labour—not only whether they give birth, but how they give birth—is central to my belief in women’s capacity to be agents in their own lives and effective political actors.  I don’t reject medical intervention when a woman needs it.  I do reject the dominant medical model that says intervention is almost always necessary.  And I reject the notion that just because birth is common we shouldn’t care about it or that birth activism makes mountains out of molehills. Minimizing issues that are unique to women is a time-honored tool in the war against us.  And it’s often in the struggle for autonomy in our everyday lives—including what some consider the mundane, uninteresting work of pregnancy, birth and mothering—where we discover what power really means.

Are women stupid?

It strikes me how often choices around birth—especially women’s choices (as opposed to choices made by doctors, midwives and other professionals)—are reduced and simplified, boiled down to the overall message that women are stupid and can’t be trusted.   

I remember distinctly during my second pregnancy when I’d tell people I was planning a homebirth being met with horrified gasps, and comments along the lines of, “Aren’t you scared?  What if something goes wrong?!”  Aside from the obvious responses (anything unknown is always a little bit scary, and something could go wrong at any moment of any day—it’s more likely I’ll get hit by a car crossing the street than have a catastrophic homebirth), I often found myself wondering if the people asking the questions actually thought I was stupid.  I got to the point where I would just retort, facetiously, “Oh, wow, I hadn’t thought of that because I don’t care at all about my health or my baby’s safety.  I’m just having a homebirth because I don’t know any better.  Plus, all the cool the kids are doing it.”  I’m not very nice when I’m pregnant.

There isn’t a lot of room in conversations about birth for the women who are actually having the babies and the reasons why we do what we do.  Our voices get drowned out amidst so much politics and ideology, and we’re left looking like idiots who really can’t manage our own lives.   For example, I read a comment in an article earlier this week about women being birth copycats:  a celebrity gives birth in this or that way, stupid sheep women follow suit.  So easy.

Spare me.

Yes, celebrities are influential.  To wit:  I became a vegetarian when I was 12 because of Howard Jones, and I joined Amnesty International in grade 8 because there was a membership table at the U2 concert I went to that year.  I bought white jazz shoes because Duran Duran wore them in several of their videos, and I still favour black clothing because of The Smiths.

But I did not plan a homebirth when I was 34 because of Ricki Lake or Cindy Crawford.  Nor did I have a c-section because of Britney Spears or Gwen Stefani (even though I do like the latter’s music, and appreciate how easy she has made it for me to teach my children to spell “bananas”). 

Celebrities can do a lot to normalize certain birth choices, and sometimes they launch advocacy campaigns of their own.  Widely publicized elective inductions and c-sections can make those procedures look like no big deal and help to strengthen a culture that encourages non-medically-indicated intervention in birth.  Similarly, Ricki Lake’s The Business of Being Born has encouraged critical thought about the birth industry to come into the mainstream, instigating conversations about things like homebirth that might otherwise never have taken place. But none of this automatically translates into women deciding to do x or y with their bodies during birth.  Taking such a reductionist approach really misses the mark. 

It seems to me, and some research appears to support this, that the notion that women make birth choices based simply on celebrity behaviour—or because it’s ‘what’s cool’ on MDC or Babycenter or among their circle of friends—is patently absurd.  It’s an assumption that allows a convenient side-stepping of the problems with the whole notion of choice in childbirth. 

There are multiple reasons why women make particular birth choices, and—libertarians be warned—those choices are rarely autonomous. More often than not, they (we) are ‘choosing’ the least problematic of the limited options available, with partial or flawed evidence plus heaps of personal constraints informing/directing the decision.  Reducing decision-making to one variable is the surest way to silence birthing women and to cut off any meaningful discussion about how to support women—how to change what is currently in North America a very, very flawed system—so that all of us can give birth in the scenario that is most comfortable, most safe, and leads to the best possible outcomes.

The painful point is:  none of us can make really good choices in a system that condescends to women as a group, and holds our integrity in contempt.

Rather than judge women for their choices, it might be more fruitful to question the professionals who control access to the bulk of the information (most women don’t have privileges at academic libraries and wouldn’t be able to read the professional journals, even if they had the time or inclination to do so), who interpret the scientific data for non-scientific audiences, and who market various forms of birth with motives that have little to do with women’s best interests.  It might be useful to bust open the false doctor-v.-midwife/vaginal-v.-surgical/home-v.-hospital dichotomies, and remember that real women’s bodies are the battlegrounds for what often come down to professional, ideological, and corporate wars.

It’s hard to make confident choices when you are doing so in the midst of a firefight.  I had a doctor literally throw my chart at me when I told her I was choosing midwifery rather than physician care for my second pregnancy.  I have been castigated for accepting interventions that supposedly led to my c-section, and accused of false consciousness for having felt empowered by my first birth because it was induced and thus not natural.  I’ve seen the same things and more happen to dozens of other women, often by professionals, but also by other mothers, many of whom react from a place of anger  or frustration with a system that may have mistreated them and/or betrayed their trust.  All of this is unacceptable.

Each one of us makes the best choices we can with the information we have available.  Information is rarely perfect or complete and knowledge is always partial, and sometimes choices made with the best of intentions turn out to be the wrong ones.  Rather than assuming that pregnant women are idiots, why not assume that they—more than anyone else—want to have their babies safely, in a setting that is appropriate for them and their families?  Why not admit that the system in which we give birth is adversarial?  What would happen if we didn’t blame women for being stupid or vapid, and instead looked at the reasons why they’re putting their trust in Ricki Lake instead of their midwife or OB?

ICAN of the Cowichan Valley

Forgive me, readers, for it has been many months since my last post.  I took a little professional detour (can you detour from an already diversified path? hmmm…).  It was interesting, and among other things, gave me an opportunity to reevaluate my values and priorities. 

And now that I’m back from my sojourn, I’ve re-prioritized my work around birth advocacy.  To that end, I’ve (finally!) gotten around to doing something I’ve been talking about for years:  I just started a new chapter of ICAN, the International Cesarean Awreness Network, here in the Cowichan Valley.  ICAN of the Cowichan Valley, like other ICAN groups, will offer resources and information about cesarean sections, and provide support to women who are recovering from a c-section or trying to avoid an unecessary surgery. 

After I had Annika, I attended one ICAN meeting down in Victoria.  But for a variety of reasons, including distance (it was a 2-hour drive, round-trip), I never managed to get to another one.  I’ve always regretted that, and wished I’d had a practical option beyond suffering in isolation with the aftermath of her birth.  I did have a wonderful circle of online friends who helped me through those years, but there is a lot to be said for face-to-face, local connections, especially in the postpartum phase.  And there is also a lot to be said for a specialized group like an ICAN support group.  It’s often hard for women to talk about their experiences with surgical birth, as many people still trot out the ‘but you have a healthy baby!’ dismissals, and unecessary c-sections have become normalized in our society.  ICAN groups can offer a safe place for women to connect with others who are likely to empathize, and willing to listen without judgment to their stories.

I’m still in the process of getting the group up and running–it was only officially registered yesterday, and I have yet to plan any actual events or meetings!  My hope is to find a central space where we can gather, perhaps beginning in late May or early June, and go from there.  So, local folks, please help to spread the word and encourage people to contact me at icancowichan@gmail.com.  Local and far-flung, like our Facebook page. Thanks to all of you for helping me let people know about this important new resource.

Taking traumatic births seriously

I went to see a new doctor this past week.  I’ve been trying for five years, without much luck, to find a doctor who is a good fit for our family.  But we live in an underserved area, and unfortunately there just aren’t a lot of good choices–the doctors who are recommended most highly have full practices and won’t even take names for a waiting list.  So I had  high hopes when I went  into the new clinic on Tuesday, and I went in with a positive attitude:  this will be The One.

Unfortunately, I think I was wrong.  It was all going okay until she asked me if I had any concerns I wanted to address right away.  I said yes, there is one.  I decided a few months ago that it’s time for me to see some kind of counseling professional to go through the details of my second child’s birth, and process what it all has meant in the nearly four years since.  Although Annika’s birth was extremely traumatic, I made only one attempt to discuss it with a professional.  When she was a few weeks old, I went to see the nurse at the health unit who was responsible for counseling women with postpartum depression.  I don’t know if I was suffering from PPD per se, but I was definitely suffering emotionally, and she was free, so it seemed like a logical choice.  She was nice enough, but after I explained the situation (planned homebirth turned emergency c-section after 5 days of prodromal labour and all kinds of crazy things happening, etc.), she told me that I had to stop “wallowing” in self-pity, accept that I had a healthy baby and move on with my life.  Given the fact that I still hadn’t gotten up the nerve to remove the bandage covering my incision, and I still needed help getting in and out of bed because of the pain, I thought her remarks were insensitive and, at the very least, awfully premature.  Needless to say, I didn’t try to talk to anyone about it again for a long time.

But on Tuesday, I decided the time had come.  I’m working with pregnant and postpartum women now, and want to ensure that I don’t project my own issues on to them.  It’s a professional responsibility as well as a personal necessity.  It’s not easy to ask for help, especially with mental health issues, but I sucked it up, put on my big-girl panties, and decided to give it a go.  To be fair, I was nervous and probably didn’t explain very well, but I was assuming that a trained family doctor wouldn’t require a whole lot of detailed explanation, that she would have either seen this before or at least have some sense of how to handle it.  The conversation went as follows.

Me: “Um, well, I’m wondering if you can recommend a counselor or a therapist who I can talk to about my daughter’s birth?”

Doctor:  “Why, did something happen?”

Me:  “Well, it was really hard–I had planned a homebirth, but we ended up with an emergency c-section, and I was pretty depressed for a long time afterward.”

Doctor:  “Is your daughter okay?”

Me:  “Yes.  But–”

Doctor (interrupting):  “Well, then, why do you need to talk to someone?”

Me:  “Um, well, I want to figure it out…figure out why I’m still bothered by it.”

Doctor:  “But your daughter is fine.”

Me:  “Yes.”

Doctor (laughing):  “Maybe it’s like some kind of [laughter increasing] post-traumatic stress disorder?”

Me (feeling ridiculous):  “Well, I don’t know if I’d go that far…I don’t know what to call it, but it’s hard.”

Doctor (still laughing):  “I don’t know anyone who really does, uh, that, but I can ask around.”

Cue me feeling like a complete idiot, totally dismissed, and wishing I’d never brought it up.

Luckily, sufficient time has passed and I’ve been around the block enough times with doctors and therapists that I could handle this–I wasn’t destroyed by it, although it was humiliating.  And I could put it in context:  her reaction wasn’t about me, it was a reflection of a large, systemic problem–ongoing stigma and ignorance about mental health issues–and a smaller problem that is a subcategory of the first:  a tendency to dismiss women’s mental health concerns, particularly around pregnancy and birth.

So instead of being destroyed I got angry.  Not in the doctor’s office, of course; there, I was a good girl, laughing with her as though she were right, as though I was silly to have brought it up at all.  I played my part in the cultural script perfectly, even though it went against everything I believe in; it wasn’t like I decided consciously to play the part, it was the only choice I could make–the possibility of pressing my concerns, of insisting she take me seriously, evaporated the second she started laughing. 

What is it going to take to change this?  I was struck while Annika was a baby by how little support there was for me to access.  Once the 6-week postpartum visit came and went with my midwives, I was on my own, and there was really no one there–outside of family and friends–to provide any kind of meaningful or helpful assistance.  And while I put on a brave face and muddled through, I think women can expect more than that–I think women deserve more than that. 

If a woman is traumatized by the nature of her birth experience–for any reason, whether or not you believe her trauma is “justified”–she deserves care, and she deserves to be taken seriously.  She is not “wallowing” or making a big deal out of nothing.  Birth is a major life event, and for some women it is one that may require days, weeks, months or years to process.  Is it wrong to ask for healthcare professionals whose jobs include pre and postnatal care to assist with that?

The doctor I saw on Tuesday should not have laughed at me.  I wish I hadn’t laughed with her, because I don’t believe it’s a laughing matter.  Birth trauma is serious.  It can destroy a person’s quality of life and impair her ability to parent appropriately; it can hurt a whole family.  Women’s feelings matter; women’s experiences matter.  Birth matters.  Stop laughing, stop dismissing, and listen.  Asking for help is really hard–if a woman has the courage to go that far, give her the courtesy of going with her and doing what you can to offer some support.

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