More Q&A With Gloria Lemay
-Questions asked by LLM and answered
by Gloria Lemay (September, 2001). This page holds
more pregnancy and childbirth wisdom from this
renowned private birth attendant. To see the first
installment, go to Q&A with
Gloria Lemay.
It's something we do for our children. It's a
good feeling knowing they got the best start possible.
It's tough to do and it tests our mettle. When
we give birth with dignity , we are more powerful
in the life that follows that experience.
2. What do you consider to be your single greatest
tool in learning about the normal birth process?
And has your view of midwifery education changed
since you began studying childbirth?
My own births are the textbook I draw from over
and over. All three births were very different,
but the one common denominator was that I was
served by women who loved me and had good hearts
each time.
I have always felt that apprenticeship was the
right way to learn the craft of midwifery. I think
that midwifery education needs to be nourishing
and compassionate toward the student. For instance,
if the student is a mother, allowances need to
be made so that her mothering is sheltered and
honoured. If the woman has no children, patience
and tolerance with her lack of personal experience
would need to be exercised. Too many learning
programs degrade and humiliate the student while
teaching a flawed, fearful model of birth. Midwifery
means "with woman". This means all women,
not just the childbearing woman.
3. Do you feel that some people resent that
private birth attendants, doulas and midwives
need to make money? Do some have a "Mother
Theresa" view of non-medical birth attendants-
thinking they should be serving exclusively
out of the goodness of their hearts?
I'm sure some do. I just wonder what my landlord
would say if I told him I couldn't pay my rent
because I am a saint? He'd say "Move out,
saint". It is childish to think that people
can do honest work for nothing. We don't expect
this of hairdressers, cleaning ladies, mechanics,
or interior decorators. I think this attitude
is more prevalent in Canada because we have socialized
medicine and people have the perception that money
is not changing hands for medical care. I notice
that people who have had a baby in the U.S. and
paid $5,000 for a normal birth in a birth centre
think it's a real deal to "only" pay
$2500 Canadian for a birth. I guess it's all relative.
I want to have a car that runs well, the best
safety equipment money can buy, a telephone that
is in service, and all the other supports to be
100% present and in good shape at births. In our
culture, it takes money to have these things.
I'm blessed because people love paying me for
what I love doing.
4. What are your feelings
regarding "malpositions" of babies
about to be born? Specifically posterior and
asynclitic.
Posterior: facing forward instead of facing
the mother's spine- this is a leading excuse
for cesarean sections being performed. Why would
it affect a baby's efficient descent through
the mother's body? Is it overdiagnosed? Should
birth attendants be aggressive in preventing/turning
such babies? Please discuss your feelings when
women who say- "I needed a section because
my doctor/midwife said my baby was in a persistent
posterior presentation."
Asynclitic: baby's head not in optimal alignment-
another reason for c-section. What are your
thoughts about this?
Babies can be born persistent posterior and we
have had this at homebirths. It takes a committed
mother and midwives who understand that patience
and gentleness will carry the day. It is rare,
and a handy diagnosis to justify cesarean.
Many of the old British midwives say that the
secret to having the baby's back anterior is to
have the mother scrub floors on her hands and
knees. I think this is a good idea because you
end up with nice clean floors if nothing else.
I personally don't even think about posterior/anterior
at a birth. If its head is presenting, the baby
will come out the vagina.
And "asynclitic"- more blame-the-mother
crappola.
5. Do you feel that the Hannah study (Lancet,
2000- encouraging breech babies to be born by
cesarean) is in any way serving the best interest
of women and babies? Are there any types of
breeches where a c-section would be preferable?
The Hannah study will eventually be taken apart
and the flaws will be exposed. In the meantime,
many babies and mothers will suffer unnecessary
trauma.
In breech birth, the first stage should be progressing
smoothly. If you have a start and stop first stage,
that may be a signal that the second (pushing)
stage will be the same way. You do not want this
scenario with a breech and this could be a valid
indication for a cesarean. It's always more reassuring
if it is a second (or more) baby and not the first
because the pushing stage tends to be more rapid
and smooth. I only have experience with 5 breech
births (all first births) at home so I do not
consider myself an expert on this subject.
6. I read thousands of birth stories every
year, and while most of them are medically over-managed
hospital births, many are midwife-attended homebirths.
I notice in the homebirth stories that it is
rare for midwives (and even some doulas) to
completely leave a woman alone in childbirth:
"naturally" inducing with castor oil,
black and blue cohosh, etc; doing lots of pelvic
exams; commandeering the mothers' pushing processes;
doing "deliveries" instead of quietly
attending births. Why is there such an urge
for so many to control the birth process? And
why are so many midwives being tempted by the
gimmicks of medicalized birth- like Dopplers,
Cytotec?
We lost birth for several decades in N. America.
The midwives were wiped out and birth became medicalized.
Many midwives (myself included) learned their
craft in the seventies from friendly Drs and nurses.
We were so hungry for acceptance and wanting to
do the "safest" thing for the mothers
and babies that we accepted many things at face
value. We also didn't have the internet and video
cameras. We created what we thought was right
but it was a far cry from the original midwifery
practised prior to the l940s. Nurse midwifery
in the U.S. has produced more numbers than lay
midwives could train so the medical model of birth
dominated.
There are a lot of open-minded, smart women out
there who I could see giving up their medical
model practise if they really knew it was better
to be hands-off. Things are shifting and changing
all the time.
7. Why do some registered midwives have such
a hard time accepting non-registered midwives?
(i.e.- sometimes "witch hunting" these
women into bankruptcy and court.)
These issues are as old as time. The physicians
used to oppress the midwives and they fought back.
Now the midwives are oppressing non-registered
attendants and a different fight is on. Power
corrupts. Compassion, maturity, and communication
are rare. I think it's important to choose the
struggle and do it with grace. None of it is personal,
that's for sure.
8. Do you feel that extensive prenatal care
is beneficial in women?- i.e.- lots of routine
prenatal checks and lab tests. If yes, which
ones?
Not extensive, but thorough. The only thing that
really benefits anyone is the fact that the woman
gets love, respect and gentle praise from another
woman and she gets some good ideas about how to
eat better. A good clinician doesn't need lab
tests to know how the baby/mother duo is faring.
Most of these tests have one purpose only--to
cover the butt of the practitioner in a lawsuit.
9. What are a few of the best ways for women
to ensure they have healthy pregnancies, births
and breastfeeding relationships?
Read the Birthlove.com Holistic
Remedies page.
10. Do attendants need to do anything to maneuver
a baby out of the mother's body?- for example-
are there techniques for "catching"
babies that only trained attendants can and
should do?
Only rarely. Stuck shoulders and after coming
heads in breech presentations are two that come
to mind. I know in the animal kingdom these problems
can result in death and so I think someone skilled
can be helpful with these rare problems but most
births could be done without assistance.
11. What would "disqualify" a woman
from having a homebirth with her first child?-
subsequent children?
I prefer to think about what would disqualify
women from having a hospital birth. Risk of infection,
strangers, unfamiliar territory, dangerous drugs-
hospitals are a very risky place to take a mother
and newborn.
The woman with the most vulnerable health is
probably at highest risk in a hospital. I view
the hospital as a place where extreme vigilance
is required in order to get a healthy woman with
a healthy baby discharged from the place. It is
mass hypnosis with no factual basis to think that
a hospital is a safe place to give birth.
12. What is a "cervical lip"? Women
are often told that they are 9.5 cm dilated,
with an anterior/posterior "lip".
The doctor or midwife then holds back the lip
to speed up dilating- often at the expense of
great pain for the mother. How do you feel about
this whole "lip thing"?
Read Pushing
for Primips. Too many pelvics is the usual
cause of cervical lips. I don't see them because
I'm not allowed to do pelvic exams except in case
of emergency under the terms of my Court Injunction.
13. Is postpartum hemorrhage more common in
a hospital birth? Why or why not? How can it
be prevented in a woman's pregnancy, then birth?
If it happens at home- how is it recognized?
What can be done to stop it?- especially non-medicinally?
Is a woman more or less likely to have a hemorrhage
if she gives birth unassisted?
Most hemmorhages are caused by separating mother
and baby. The baby climbing on the mother skin
to skin is what prevents hemmorrhage. Then, pulling
on the placenta is another cause. The attendant
must wait a full 30 minutes after the birth before
the placenta is even mentioned.
Most important things: keep mom and baby skin
to skin, they should be lying down, warmly blanketed,
mother given warm fluids to drink, no hat on baby,
no telephone calls.
14. What is calcification of the placenta,
and what are your experiences with it?
Many women are told their placentas are calcifying,
thereby increasing the chances of poor outcomes
in postdates pregnancies. More crappola. Why would
the good Lord in Heaven invent baby heart, lungs,
thyroid, adrenals and other organs that function
just fine and make a mistake on the placenta.
I've seen lots of calcified placentas --so what?
They work just fine.
15. Should postdates women be induced? Why
or why not? Is there a maximum time limit on
how long a pregnancy should "go"?-
and does this number apply to ALL women?
This is the insanity of North America. Women
in good health (non-smokers, with normal blood
pressure, and no history of diabetes) are best
left to have the baby by Nature's clock. There
is no SAFE induction method.
16. An increasing number of c-sections are
being performed all around the world- even at
the expense of women's' lives?
Because we prize aggressiveness. When something
goes wrong, we want to know "Why didn't they
do something?" Doctors, like the rest of
us, are complete cowards. All they care about,
like the rest of us, is "How can I stay out
of trouble". When we understand this, we
stop looking for them to be our heroes and start
taking responsibility for our own births.
17. Do you feel a woman is better served by
a medically-oriented midwife at home, or a gentle,
non-interventionist doctor in a hospital?
Depends on when they call that medically-oriented
midwife. If she comes over four hours after the
baby is out, I guess she's a better bet.
It's assault.
19. When you're at births, what sort of help
do you appreciate most from invited friends
and family members? How can such people serve
the birthing mother best?- both before the birth,
during and after?
I like them to make me Red Rose Tea, with the
milk in the cup first, and then the tea poured
over. If they do this several times through the
birth, I will love them forever. If they also
wash dishes continually and clean the bathroom
from top to bottom we may let them shoot the video
as well. If they stay really, really quiet and
still while the couple greets their new babe they'll
get the grand prize birth attendee Cup.
Buy the hospital and pay all the staff a bonus
for doing nothing. In a midwife-attended homebirth?-
have a big husband with a German accent.
21. Is it possible for a doula, birth attendant
or relative to successfully advocate for a woman
in a hospital birth?
Possible but unlikely. Even if you are fairly
well-read, the hospital staff will have more distinctions
than you and will be able to over-ride the advocacy
you are trying to do. For instance, if the advocates
are saying "She doesn't want an epidural"
the staff will say "This woman is exhausted.
If she doesn't get an epidural and some rest now
she'll end up with a cesarean pretty soon."
Now, what would most people respond to that? It
gets scary and they know just what to say to shut
you up.
The big problem I see in hospital births is that
the family do not know for sure who the nurse
on duty for them will be. If the nurse is a big
fan of natural birth and is fit and eager to coach
the mother, a natural birth is a possibility.
If the nurse is in poor health and feels that
natural childbirth is a martyr trip, she won't
have the physical or emotional stamina to assist
a normal birth.
This is what true midwifery is to me- a committed
individual that you know in advance and can trust
to give you 100% at the time of the birth. Midwives
in group practise or working in a hospital setting
supervising nurses doesn't meet my criteria.
Yup. Men are territorial and they do better on
their own turf than they do in another male's
territory. Just look at the importance of "home
games" in sports.
Men also think better when they are in motion.
Their brains are designed that way. In a hospital,
they are restricted in their movement, worried,
and in unfamiliar territory. This combination
disempowers them.
23. If you were in charge of how women in twenty
years give birth- what sort of birth choices
would they have?
Unlimited. My goal in life is to have my province,
British Columbia, be the best place on the planet
to have a baby. Women will fly here from all over
the world because there are so many choices. This
will be a place where you can have a waterbirth,
birth in the ocean or forest, be in a hotel, apartment,
clinic, birth centre, hospital, house, have Buddhist
chanting, Lotus birth, respect for all religions,
traditions, ceremonies, everything imaginable
and a few I haven't thought of yet.
Once it happens here, of course, simultaneously
the whole Planet will transform and every other
place will be that wonderful, too. I have no idea
how to accomplish this but I am generating the
vision at all times.
The lost potential of a fundamental, special
experience.
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