Why I Won't Be Doing Prenatal Screening

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In Ontario (and most of the developed world), pregnant women are offered something called Prenatal Screening. The screening usually involves both blood work and ultrasound, and is done at around 11 weeks.

In my first pregnancy, prenatal screening wasn't really offered as a choice to me. I began my pregnancy under the care of my family doctor, as I was still on the waiting list to get a midwife. Midwives practice something called informed choice - you are given all the relevant information about specific tests/procedures, and then it's up to you to make the final decision.

Most doctors, however, do not practice informed choice, and instead tend to offer up tests/procedures as the "normal" thing to do. There's a whole body of evidence out there which shows that most clinicians are not successful at involving their patients in making health care decisions.

So when prenatal screening comes up in pregnancy, it's not so much a choice, as it is "the thing to do." And so I did!

If women understand the consequences of the screening, and have a good grasp on what they would do with the information, then there is no problem. But when women are unsure, or consent to procedures without really understanding what's going to happen, then it is a problem.

Screening tests for three things - Down Syndrome, Trisomy 18 and Open Neural Tube Defects. You will be told your chance of having a baby with these conditions (e.g. 1 in 250), and if your chance is higher than expected, you have a positive result. This does not necessarily mean your baby has one of these conditions, but it does mean you're offered further diagnostic testing (usually in the form of amniocentesis, which carries its own risks). If an accurate diagnosis is made through amnio, then you have three options:

1) Prepare yourself for life with a child who has disabilities, or a child who will die shortly after birth (depending on the severity of the condition)

2) Plan to give your child up for adoption if you feel you cannot handle caring for a child with disabilities

3) Abort your pregnancy

Clearly, none of these options are what any parent wants to go through. We all want to have a healthy child. But once you choose to undergo prenatal screening, you must be able to think ahead and imagine what you might do with the information you are given. If you get a positive result, will you go for amniocentesis (despite its small risk of miscarriage)? If you get a diagnosis, which option will you choose?

Testing for these conditions also raises a number of ethical issues, and potentially better screening tools soon to come on the market may have parents choosing to abort before they've had a glimpse of their baby via ultrasound or through movements felt - before any kind of bonding has occurred. Some experts suggest that the abortion rate for parents who discover their baby has Down Syndrome could be as high as 90%. Parents of children with Down Syndrome are concerned over this fact, as clearly, children with Down Syndrome are just as loved/special/amazing as children without the extra chromosome. As genetic testing becomes more advanced and available, you have to wonder where this will take us? How far is too far?

The 90% abortion rate definitely scares me. As a second time parent, I have firsthand experience loving a child. I bonded with my baby immediately upon discovering I was pregnant this time around. But as a first-time mom, I remember the baby in my belly being kind of abstract. Bonding didn't happen until later (and probably even later than it happens between most other mothers and babies). If the test had discovered one of the three conditions, would I have considered abortion and gone on to have major regrets? Part of me thinks "no," that I would have just prepared myself for life with a child with disabilities, but I wonder if other mothers out there have regretted the hasty decision.

So this time around, we have opted not to do prenatal screening. If I received the diagnosis during pregnancy, I don't think the information would be good for my well being. I'm a worrier, and my anxiety would probably rise to unmanageable levels. Plus, I'm a kinesthetic learner - I learn by doing and experiencing, not by reading books or observing other people's experiences. So life with a child with disabilities would be a shock, but I would need to learn as I went along.

Plus, as my midwife put it, "if you're a woman who believes in letting nature take its course, then prenatal screening is probably not the right choice for you." And that's exactly who I am - I believe that all things happen for a reason, and I would be willing to go down a difficult path if I needed to. Even one where I might have to say goodbye to my baby shortly after birth.

What is your experience with prenatal screening?

{Ottawa Doula} Sabbatical

As this pregnancy moves along, I am reminded daily that I will soon be taking a sabbatical from birth doula work. Every visit that I make to my client's homes and every baby that I witness coming into the world is bittersweet. I know that soon I will be the one on the birthing stool, and although I anticipate the joy of this, I know that my days of jumping out of bed to attend a birth at 1 a.m. are numbered.

Turning away clients has so far been the hardest part. I will not be taking on primary clients after August 1st (although may provide occasional backup for my doula friends). With each email I send out, I don't mourn so much the loss of income or "business," but more the loss of an intimate connection with people on the path to parenthood.

In this job, there needs to be boundaries (of course), but these boundaries are loose and sometimes transparent. I witness what we normally deem to be human frailty, or perhaps loss of control. As we go about our daily lives, meeting and working with other people, it's unlikely we have the opportunity to see the nakedness of our humanity - to see ourselves as we have always been. Animalistic, primal, and grounded.

Palliative care nurses may say the same - in our jobs, we see the essence of this life. We witness the comings and goings; the circle as it begins and completes. It is whole, it is real, and it never ceases to amaze me.

But doula work is hard with little ones around. You must have someone who is willing to take your kids at the last minute, and sometimes at unpredictable hours (depending on what your husband does - mine does not have a 9-5 job, and so we sometimes need childcare before 7 a.m. or after 5 p.m.). As well, you become that person. The one that cancels last minute, or just never shows up to events or appointments. The one that can only make plans by saying "however, I'm on-call for a birth at that time..." The one who can only travel if she takes 4 weeks off, and doesn't get paid for vacation.

As well, doula work does not pay a lot. Most people balk at the cost ("what!! You charge $550 to attend a birth?!"), but depending on the length of the birth and the hours I have dedicated to pre and postnatal care, I'm sometimes getting paid $15 per hour. For our family, full-time doula work (4 births per month) would not pay the bills. I've also come to the conclusion that my current life, with 3 days per week of work at the hospital and 2 births per month, while caring for a preschooler and a small baby, would be madness.

So despite the fact that I think I've found my calling; the thing I've always wanted to do with my life, I may need to step away for a while. Or at least until I can find a way to manage my home, love my children, give my hubby the attention he deserves, be a good friend/daughter/sister, AND attend births...all at the same time, and with a smile!

But stepping away doesn't mean saying goodbye. I'm happy to say I will soon be teaching prenatal classes with Birthcare. And with that comes the occasional backup I can do for other instructors, who are all doulas themselves. It may also be possible for me to do extra training in breastfeeding and postpartum doula care, which although the market is highly saturated, may offer some better daytime hours. And I will certainly never turn away a repeat client - the joy of following someone through to their second (or third!) pregnancy is too much to give up.

So, my hope is to have the best of both worlds. To keep my foot in the door, for when I feel like life will allow me to return. Giving up on my dream job is not an option. Allowing my dream to work alongside reality, is.

Are you a small business owner or doula? How do you manage to balance work life with small children?

For the joy of it

Remember this post? I had Feist's song stuck in my head at the time...

The decision to have a second (or third, or fourth, or...) baby is a deeply personal and highly charged decision. Or maybe not. Maybe your decision was quite simple - at the age of 16, for instance, you decided that you would have exactly 2 children. One boy, and one girl, for good measure.

For me, the decision was deeply personal and convoluted. There were moments where my husband felt ready for another baby, and I felt ready for my next glass of wine. Then there were moments where I felt the tug of baby as an ancient and powerful female desire. My uterus was literally calling out to me. And at these moments, hubby was quite content to head to the fridge for his next beer.

All of a sudden, though, we seemed to click. We began tentatively discussing "if," and then soon we were discussing "when." It came down to this: we ultimately could not see ourselves moving on in life without inviting another little person join our clan.

Maybe this little person would decline our invitation. Maybe once they showed up, they would be the unwelcome house guest (or that douche bag roommate you lived with in college) - getting drunk and rowdy, staying up too late into the night, waking us up at ungodly hours. Maybe they would even cry a lot and be emotionally dependent.

But we felt compelled to write the invitation.

Because buried within the chaos of The World of Newborn, there are hidden gems, worth ten times the frustration, sleep deprivation, guilt and sadness that may come along with parenthood. And with each "phase" there comes more joy and laughter  - when you meet your partner's eyes over the top of your child's head, and mutually bask in the question "did we actually make this little character?"

In the words of Peggy Vincent, we took a leap of faith, "just for the joy of it."

I may question my parenting techniques, my ability to be a good mother, and, let's be honest, my sanity. But what I will never question is whether I have the capacity to love. I will never wonder whether there will be joy. I will never wonder whether I made a mistake, because there are no mistakes in motherhood - there are only solid stepping stones of success and personal growth (and yes, these come with heartache and occasional exhaustion!)

And although I must sound as though I'm walking through the valley of the blissful-pregnant-lady, I'm also highly realistic of what's in store for us. Which is why I realize that my birth doula work may need to be on hold for a couple of years; and why I might need to be resourceful in finding ways to make money AND be a good mom; and why I need to stock away every last penny right now, in order to survive the bare-bones EI benefits I will receive; and why I might need to swallow my pride and just reach out for help.

So with eyes wide open, we moved forward, and extended the invitation. And a miniature someone received, and accepted.

Onya Baby: Guest Blogging

Onya Baby is a family-owned company that makes super awesome baby carriers. I was thrilled when Diana from Onya Baby asked me to guest post today, in honour of World Doula Week.

Swing by and check out the post: A Day in the Life of a Doula. And while you're there? Learn more about the benefits of carrying your baby! Your days of lugging around that car seat may soon be over...

Happy Weekend!

Anna Belanger (and a little announcement)

Early pregnancy was not much fun for me. Actually, to be honest, I didn't enjoy pregnancy in general. Some women are very content in their changing bodies - they eat healthier, exercise more, and seem to blossom with each passing day.

I, on the other hand, morph from a relatively smart, functioning woman, to a vomiting, sobbing and snotty mess. I didn't eat healthy at all in the first few months. I followed the "white" diet - white bread, white pasta, and maybe some ice cream. I was sick constantly, and my moods fluctuated like this unseasonal March weather we're having. I also developed what I called the Crazy Ear Disease (otherwise known as Patulous Eustachian tube, a very rare disorder that seemed to be triggered by the pregnancy hormone Relaxin), which followed me right through to the birth.

Add to that the fact that dear daughter was an unplanned pregnancy. Yes, of course I'd thought about children (I was 28 years old after all); I just didn't think it would happen 3 months following my wedding, at a time when most couples are excited to spend their honeymoon phase travelling or saving money to buy a house. And despite my age, I knew very few friends who were pregnant or had given birth. So there weren't a lot of people to turn to in the months following conception.

One morning, after my routine of dry heaves and soda crackers, hubby brought me his local business newspaper - a publication that highlighted business news in the Ottawa area. On the front cover was an announcement that a local massage therapy practice had hired their first Massage Therapist who was trained in pre- and post-natal massage. Her name was Anna Belanger.

I booked myself a massage, and arrived not quite knowing what to expect. I had been for massage therapy in the past, but never with a growing belly. Anna introduced me to her special "pillows," which allowed me to lie on my tummy, with my belly and breasts hanging comfortably in the curves of the pillow.

Well let me tell ya': that first massage was an eye opener. I left the clinic practically floating to my car. And not only did I feel good physically, but I also felt a renewed sense of hope. Finally, someone got it. Someone was able to relate to my nausea and vomiting, my pregnancy neuroses, and my anxiety over becoming a first time mom. As a mother of four, Anna could relate to all of my worries. She not only helped to reduce these worries, but added some much-needed humour to the situation.

I continued to see Anna throughout my pregnancy, and then in a moment of fate, asked her to be the backup doula for my birth. The woman I had asked to be my primary doula was going away to a wedding 3 days following my due date. Anna's spidey senses told her that she would be the one attending my birth, and she was right! Anna provided continual support throughout the birth of my daughter, and got to witness even more of my puking, snotty self :) In the postpartum weeks, she was the one who taught me how to breastfeed lying down, as we practiced right on her massage table! Newborn babies are always welcome in Anna's clinic (although let your hubby take the baby away after the cooing and ahhing is over - you need to enjoy your postpartum massage!).

In the years since that first massage, I have remained one of Anna's devoted clients, and have watched her small business grow into a booming niche-clinic in the Glebe. And although you'll hear some occasional selfish complaints from me (e.g. I have to wait how long to see you again??), I am over-the-moon with joy for her and her associates. It was because of Anna that I am now a doula myself, and share her passion for working with women.


So when I peed on a little stick several weeks ago and saw this.....

The lines kinda fuzzy, but it's there :)

....I knew who I needed to call. I'm excited that Anna will be able to attend the birth of baby #2, and I'm also thrilled that I now have an excuse to book a monthly massage (not that I needed one!)

As women, we are destined to live through such a multitude of scary, joyful and heartbreaking experiences, and it's a must that we surround ourselves with people who "get" us. Some of us are experiencing loss. Others are dealing with the ravages of infertility. Many of us are moving through pregnancy and birth. Some have no interest in babies at all, but are struggling with other physical and mental health concerns. And some are witnessing the drastic hormonal shifts that occur as we say goodbye to our childbearing years. In all of this, a gentle hand and a kind word is all we need to be able to take a deep breath, and relax into our bodies - as imperfectly perfect as they are.

So if you are a woman living in the Ottawa area, do yourself a favour, and book a massage with Anna Belanger and Associates.

And join me in taking a deep breath...here we go again!!

Continuous Fetal Heart Rate Monitoring: Hospital Admissions

I've been posting a lot of research lately, but it is because research is just so great :) Really, can you think of a better way to grow and develop as a society? Research teaches us what has been, and maybe what should be. At its best, research results in positive change (there is also research at its worst, but that is a story for another day...)

I came across this recent systematic review from The Cochrane Library. [Side Note: If you don't know what The Cochrane Library is, and you are interested in health care (either personally or professionally), then you should be finding out! The Cochrane Library is an independent organization that conducts high-quality reviews, which provide evidence for health care decision making. Ever wonder why a doctor will prescribe a specific drug for your ailment? It's because of reviews that the doctor is able to read, in one paper, a summary of all existing evidence on a particular drug. If the evidence overwhelmingly shows in favour of the drug for treatment, then bingo! You get a prescription.]

The paper I linked to above is about cardiotocograph (CTG). When you go into labour and believe that it's time to head to the hospital, you will be assessed in triage. You're led to a little room, where the nurse will strap you to monitors which will record your baby's heart rate. This is normally done for about 20 minutes, during which time you will receive a cervical exam, and either be sent home or admitted to a room.

Granted, this is not done at all hospitals. Some will just listen to the fetal heart rate intermittently, quickly check you, and then determine whether it's time to be admitted. But generally, CTG is the way that things are done if you are under the care of a doctor or obstetrician (this blog post states that 76% of Canadian hospitals use CTG upon admission)

Why is this important? The Cochrane review that I linked to above found that c-section rates increase by 20% for women who undergo CTG compared to intermittent monitoring. Interesting, isn't it?

Science clearly shows that low-risk pregnant women should not be monitored continuously. In fact, this is an intervention that Lamaze International recommends you try and avoid, because continuous monitoring shows no benefits - only harm. Harm in the form of abdominal surgery, apparently.

In my experience, women that are strapped to monitors upon admission to hospital generally become agitated and no longer cope very well with their contractions. Not surprising, given that they are forced to lie in a bed, in a tiny clausterphobic room, and listen to the clippidy-clop of their baby's heart.

And yet, despite all the overwhelming evidence that shows that this type of monitoring can be harmful, we're still doing it! As I wrote in a previous post, it's all about the lag time between research findings and shift in practice.

But you know what does change policy? That's right - you dear readers! The women out there giving birth have the right to ask for good evidence-based care. When more women request a procedure (or decline a procedure), policies change over time to accommodate patients' wishes.

What has been your experience with hospital admission? What do you think of this 20% increased risk in c-section?

{Ottawa Doula} Another home birth "nightmare"

Sorry folks, you'll notice I'm unabashedly just linking to other great articles lately - I promise to have new (original!) material posted soon.

I had to share this blog post with you, by one of my favourite bloggers The Feminist Breeder. Her use of the word "douchecanoe" (which supposedly comes from another blogger) had me laughing out loud.

To help you with the context, you need to read this article first.

Regardless of your personal decisions/choices, society as a whole needs to understand that home birth is not only safe but also an essential option for some women. If this option were taken away from us (which it wouldn't be, because frankly, you can't control my vagina or how my baby comes out of it), this would be a violation of our reproductive rights as women.