{Ottawa Doula} Don't Be a Martyr About It!

My last post on cesarean section rates here in Ottawa highlighted an issue that I had left out of the conversation. Someone commented that the epidural rate in most hospitals in Ottawa is 90% (it's actually more in some hospitals), which is indeed true.

I avoided making the link between epidurals and c-sections because, a) there is no conclusive evidence that epidurals increase the likelihood of cesarean section; and b) doulas provide non-judgemental support. Therefore, I have no opinion on epidurals. If my client needs one, I support her. If my client feels strongly that she doesn't want one, then I support her. Case closed.

However, I know it's not that easy. Women become doulas because they are inspired by birth, often in its most natural form. Either we have birthed naturally ourselves, or we have had a difficult birth experience that has led us to seek out alternatives. (And of course, there are wonderful doulas who have never given birth). Therefore, some doulas avoid clients who plan on getting an epidural. I respect the fact that doulas need boundaries too, and I think it's best to be upfront about what kind of doula you are.

I call myself the "middle-of-the-road" doula. I have experienced and seen natural births that have been magical, but I have also witnessed births with epidurals that have been just as special. I think that pain management (in the form of pharmaceuticals) has its place in modern care, and I know that certain labours require a woman to be able to rest and find relief.

That said, a rate of 90% is high. Really high. This would be all fine and dandy if epidurals were risk free, but they're not. They come with both short and long-term side effects, and some women are traumatized when their epidurals don't work like they should (imagine going through labour with only one side of your body frozen).

So what's convincing 90% of our population to try for pain free births? I like to call this the anti-martyrdom syndrome.


A martyr (in the non-religious context) is someone who undergoes severe or constant suffering. Another definition is someone who seeks sympathy or attention by feigning or exaggerating pain.


When I was pregnant with my first child and decided to try for a natural birth, I quickly realized that the majority of people I met would not be supportive of this decision. The most typical response I got was "oh, just you wait. You'll be begging for the drugs." I never once had a woman (or man) say "way to go," or "it's easy, you can do it!" (actually, scratch that. My boss at the time was the only one who gave me a positive story of her own natural birth).

And what I heard (and still hear) most often from women was that they didn't want to be a martyr about it. Meaning, they didn't want to purposefully suffer just to birth their babies.

In short, childbirth = suffering. It's been that way for a long time, and although a small contingent of brave women have tried convincing us otherwise, 90% of us still believe it.

Our hospitals make it well known that epidurals are the "better way to go." Doctors, OBs and nurses are not trained to support women through natural childbirth, so obviously, they're much more comfortable with women who get the drugs. Our whole society and health care environment is screaming to women don't be a martyr about it!!!

And if you want to bring a feminist argument into the mix, hasn't it always been this way? From the first time we start to bleed, we're immediately pegged as martyrs - people who seek sympathy or attention by exaggerating pain. God forbid we should complain about menstrual cramps or heavy bleeding, and the women who miss work due to monthly migraines are just slacking off. Any emotional response we may have to an issue is immediately written off as "PMS-ing."

Let's also compare this situation to the world of long-distance running, extreme sports, or those who scale Mount Everest. Clearly, many of these people are suffering - the throngs of runners collapsing into unconsciousness at the end of a marathon makes me shake my head and laugh. It's amazing to me that they'll put their bodies through hell just to achieve a rush of adrenaline. And yet these same people (both men and women) are intent on avoiding the pain of childbirth, despite the fact that natural childbirth offers the same rush of adrenaline and ultimate joy. I wonder what would happen if I began telling all those people who do marathons or extreme sports, "Hey! Pull up a bag of potato chips and plunk yourself down on that couch! Don't be a martyr about it!"

In an ideal world, the majority of women in childbirth would not be suffering. As I've stated above, there are instances where suffering becomes apparent, and relief in the form of pharmaceuticals is not only needed, but welcomed! However, when women are given proper support, and a calm and caring environment in which to birth you would be amazed at what we can do.

But we're not living in an ideal world. These days, women don't have proper support, don't have a calm and caring environment in which to birth, and go into labour with an inherent belief that childbirth is a form of slow and terrible torture. The epitome of suffering. It's only a small percentage of women that are asking for more - hiring midwives and doulas, and choosing a place of birth that supports a model of women-centered care. These are women who are surrounded by other women (and men!) letting them know that childbirth is not frightening, is not suffering, and heck - might not even be painful!

So frankly, I don't blame any woman for wanting an epidural - put in the same situation 90% of us find ourselves today, I wouldn't want to be a martyr about it either!

{Ottawa Doula} Hospital Cesarean Rates

Hospitals are required to disclose their cesarean section rates, but the information is hard to come by without a lot of searching. Most women are admitted to hospital without any prior knowledge of their c-section risk, and will often be surprised when the birth ends up in the operating room.

Each hospital in Canada has a different cesarean section rate because policies and procedures differ from institution to institution. These are policies related to how women are "allowed" to labour and give birth. Things like timing of induction (how long you can go past your due date), electronic fetal heart rate monitoring (EFM), use of Pitocin and IV fluids, and length of pushing time are all regulated by hospital protocol.

Recently, we've seen a number of stories in the media sounding the alarm bell on the rising c-section rates in our Canadian cities. I came across this handy website today, and thought it would be interesting to share the c-section rates at various hospitals here in Ottawa.

Montfort Hospital: 25.8%

The Ottawa Hospital: 29.17%

Queensway Carleton Hospital: 33.18%

Almonte General Hospital: 25.91% 


Winchester District Memorial Hospital: 21.63%


The website also publishes each hospital's VBAC (Vaginal Birth After Cesarean) rate. Scraping the bottom of the barrel is the Queensway-Carleton Hospital, at a dismal 7.63%

Does this mean that women in Ottawa who want to avoid a cesarean section should plan to give birth where their chance of c-section is lowest? This, of course, is a personal choice, but I believe a wiser strategy would start with demanding more evidence-based care from our hospitals. In my opinion, policies and procedures are governed first by consumer demand, and second by evidence-based information (which is ridiculous, I know). The more you are complacent about what is being done to you, the more you pave the way for other women to have the same done to them. [and of course, some c-sections are necessary and medically indicated. Clearly this conversation does not apply to those women, although they still have a right to respectful and informed care]

So if you're under the care of a doctor or OB at one of these Ottawa hospitals, and you hope to avoid a c-section, what should you be asking about?

1) How will you monitor my baby's heart rate? (there is no evidence showing that continuous EFM is beneficial, and there is an increased risk of cesarean section when it is used)

2) If I go post-dates, when will I be induced? (Most OBs are following the 40+10 rule - when you are 41 weeks and 3 days, you will be induced. Again, there is evidence showing that healthy, low-risk pregnancies can extend to 42 weeks without increased risk to mom or baby)

3) When do you feel the need to use Pitocin during labour? What are my other options if you feel that my labour has stalled? (psssst...hire a doula. They have some neat tricks for getting labour to progress!)

4) Do you use routine IV fluids during labour, or can I eat and drink whenever I want?

5) If my baby is doing well, will I be able to push past the allotted time given for second stage?

Also keep in mind that the whole team of OBs needs to be on board with the terms/conditions you have in place. If you decide you absolutely do not want to be induced at 40+10 days, then you will need to be prepared to meet with resistance if your OB of choice is not on call around that time.

Pregnancy shouldn't be a time that women need to do battle to get the care they want. But as you can see above, the reality is, 1 in 4 women will have a c-section in Ottawa (and sometimes that number reaches close to 1 in 3). So it's up to you and your partner to fight for the care you need - doctors are often prepared to listen, but it's our responsibility to make sure we're heard.

And of course, you've heard the same old from me time and time again....hire a doula and that percentage goes down...blah blah blah....get a midwife and that percentage goes down...blah blah blah....have a home birth if you're healthy and comfortable with the idea...blah blah blah.

You get the picture!

What do you think? Are my local Ottawans surprised by these rates?