birth of a notion

On April 23, at 6:30 a.m., Sharlynne Pickering’s water broke. At first it trickled, then it gushed. At 7 a.m., she called Stacy Calogero, a doula assigned to give her physical and emotional support during labour and childbirth. Calogero arrived at Pickering’s apartment at 9:30. She made hydrating popsicles, calmed Pickering with stories and monitored her contractions. She maintained regular contact with a doctor on call from B.C. Women’s Hospital and Health Centre, which gave husband Bill Pickering time to pack the car. By the time Dr. Joan Robillard arrived, Pickering’s cervix was more than nine centimetres dilated, unusual for a first pregnancy. At 10 centimetres, it’s time to push.

Pickering didn’t know if she was going to make it.

“I looked at Stacy and I said, ‘Stacy, I don’t think I’m going to make it to the car. I don’t know how I’m actually going to get off this bed and walk down those stairs and make it to the hospital,'” the slender 32-year-old says. “And she just looked at me with the calmest and most matter-of-fact face and just said, ‘Sharlynne, you and your baby are going to walk out of here together no problem.’ And I just went from ‘There’s no way I’m going to make it,’ to ‘I can do this no problem.’ It was just the way she looked at me.”

Pickering made it down two flights, into the car, to the hospital and swiftly into the delivery room. Seventy-eight minutes later she bore a healthy baby. Seven months later Liam James Pickering bounces happily at family home in his ExerSaucer, blue eyes alight in his cherubic face.

The Pickerings were matched with Calogero through the South Community Birth Program, a project started nearly two years ago by physicians and midwives from B.C. Women’s Hospital and Health Centre. They wanted the program’s integrated care team, prenatal classes paired with checkups and support from volunteer doulas to provide women and their partners with comfort and care to counter the fear and isolation often associated with pregnancy and labour. So far, it’s the only project of its kind in North America, and other health jurisdictions are taking notice.

The Pickerings say they can’t emphasize enough how well the program worked for them. Although a postpartum health crisis did develop, Pickering says her experience with the program has been entirely positive thanks to help from doctors, midwives, community health nurses, her doula and the mothers she met in the prenatal classes. And her happy memories are the proof.

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Pickering first heard about doulas last fall when she told her coworkers she was pregnant. A colleague suggested she talk to his mother, who is a doula. Named after the Greek word for woman-servant or caregiver, doulas provide information and support for mothers throughout labour and childbirth, teaching them about breathing techniques, positions, massage, aromatherapy, and discussing whether they want pain medications offered. Pickering met the doula and was sold on the service. But just as she was prepared to pay the typical $500 to $600 fee doulas charge, she picked up a pamphlet for the South Community Birth Program and learned she could have a doula for free if she enrolled.

She called the program, housed at the South Community Health Centre, and learned it primarily serves women who live between Angus Drive and Boundary Road, East 41st Avenue and the Fraser River, but was opened to all Vancouver residents following its slow start.

“When I came across the program I was like, ‘Wow, there’s all these different doctors and all of these nurses and doulas and they’re all passionate about delivering babies-cool,” Pickering says.

A doctor or midwife from the program monitors each woman who participates. All births are at B.C. Women’s Hospital, after which the mother and baby’s care is returned to the family’s physician.

As with two-thirds of the 200 women who have enrolled in the program, Pickering was pregnant with her first child. She and her husband started attending the program’s free prenatal classes, which can cost more than $150 through public or private providers. A doctor or midwife and a community health nurse run the 10 two-hour sessions. Each woman receives a monthly checkup, which eventually becomes bimonthly, at the end of each class.

On average eight expectant mothers, aged 18 to 43, and two partners, attended each session. Most were from South Vancouver and didn’t speak English as a first language. Despite their different backgrounds, Pickering found she had a lot in common with the other women.

“It feels good when you have a concern and then two or three other of the mothers pipe up and go, ‘Oh, I was wondering about that.’ And then I’m like, ‘Oh, OK, I’m not totally psycho, this is actually a normal concern,'” Pickering says.

Pickering liked the combination of classes with checkups, and she believes midwife Valerie Perrault, who ran her group, saved her from having a Caesarean. During one checkup, Perrault noticed Pickering’s pubic bone had shifted. Fortunately, her chiropractor fixed the problem with a quick adjustment.

The groups cover various topics about labour and parenting. One mother, a veteran of the program, demonstrated breastfeeding.

“At first I thought, ‘Really, c’mon, how hard can [breastfeeding] be?'” Pickering says. “I know now, it’s not as easy as I thought.”

More than a dozen of Pickering’s friends have children, but she says there’s nothing like receiving answers from pregnancy specialists.

“Rather than hearing it from a friend, where it’s, ‘Well, they say it’s OK, but I’m still really not that sure.’ Once you hear it from a professional, you’re totally relieved.”

At the start of her third trimester, Pickering was matched with Calogero as her doula. They met three times before Pickering went into labour. Calogero answered questions, explained how she would help and prepared Pickering for what to expect when she gave birth.

Calogero also knew how to be discreet at key moments in the birth.

“It felt like it was just Bill and I although she was there supporting him too,” Pickering says. “It really felt like it was our experience.”

Bill agrees. “I felt I was able to support Sharlynne better by having Stacy around,” he says.

Linda Knox, a midwife with the program, says the partners of mothers often don’t know how to provide the comfort women in labour need.

“First of all, you’re throwing them into a hospital, which is a foreign environment for anybody, and you’re expecting them to support this person that they love through what looks like they’re being tortured, and they’re like deer in the headlights,” she says. “And we’re expecting that they should be a labour coach. It’s a bit absurd if you ask me.”

Knox has seen many women disappointed with the support they’ve received from partners. Pickering wouldn’t hesitate to hire a doula in the future. “Honestly, I can’t imagine doing it any other way.”

Pickering received similar intuitive care from Dr. Joan Robillard, the program’s doctor on call. Pickering had once watched a TV program about childbirth in which a mother in labour reached over her own belly and pulled her baby out. She thought this practice “was really cool” but had never talked to the doctor about it.

“And for some reason, she just looked at me and she said, ‘Take your baby,’ and I did,” Pickering says with a lingering trace of awe. “I just leaned down and I put my fingers under his shoulders and just pulled him out of my chest.”

Six weeks later, Pickering, Liam and Bill were at a park when she began to feel ill.

“I said to Bill, ‘We’ve got to go home,’ and within an hour I had a fever of 104 and I was pretty much delirious.”

Pickering had seen a doctor at a breastfeeding clinic the day before and been told she had a breast infection. The doctor gave her a prescription of which Pickering took two doses.

Bill called the program’s emergency line. Perrault immediately returned his call. She told him to take his wife to B.C. Women’s Hospital if her fever continued.

“They were in communication with the doctor on duty through our program at B.C. Women’s, so literally all we had to do was just drive there and I went right into a bed and the doctor was there,” Pickering says. “I think the biggest thing in that whole situation was how the midwife was able to help me… She even came to check on me the next day because I had to stay 24 hours.

“We had a six-week old baby that was screaming in my husband’s arms,” Pickering says. “If we didn’t have that number to call we would have just gone straight to the emergency… I may have been in that waiting room forever and not known what’s wrong with me, whereas I’m on the phone with Valerie and she’s just like, ‘Sharlynne, this is what’s happening.’ She explained everything to me.”

Instead of feeling panicked and alone, the Pickerings felt they had support.

Kiran and Sarbjit Dubb know what it’s like to feel panic.

Three years ago when Kiran gave birth to their second daughter, Dipika, the couple, who emigrated from India to Canada in 1999, found themselves alone.

“When she was born, we went to the hospital first in the morning time, they sent us back,” husband Sarbjit Dubb says. “They said three, four hours you have to stay home. Then we went there I think about three o’clock, then she was born. But nobody helped.”

No one at B.C. Women’s Hospital spoke to them in Punjabi, the language Kiran is most comfortable with. After Dipika was born, they waited three hours in the delivery room to be transferred to a bed. According to Sarbjit, the baby’s placenta remained in a basket nearby for three hours. “Nobody cleaned it,” he says.

With the support of the South Community Birth Program, Kiran’s third labour was a very different experience. Speaking through her husband’s translation, Kiran says she benefited from nutrition counselling in the prenatal sessions and learned for the first time how to manage pain. A Punjabi-speaking doula visited her at home during her pregnancy. Another doula who also spoke Punjabi assisted during the birth when the first was unavailable.

“In the hospital, the doula was standing behind Kiran,” says Sarbjit. “She was just telling her-she was holding her hand-what to do and how to breathe and how to reduce the pain. Like I can’t do, because I don’t know anything about that.”

The help was so effective that Kiran didn’t need any pain medication during birth. Sarbjit highly recommends the program to others.

“Whenever we called them, the help was there. That’s the main thing. Like we weren’t scared. We were not nervous or anything. Help was there always. Like in the nighttime, too, whether it’s one o’clock, nighttime, they would call us back right away.”

Pickering’s friends can’t believe the support she received. Many live outside Vancouver and are not eligible for the program.

One friend had a particularly frightening delivery. “She looks back on that and she’s still got things that are unresolved,” Pickering says. “Who knows how it may have gone differently had she had a doula there… I know that it would have made a difference for her emotionally, you know, having somebody explain and really talk to you about what’s happening to you and why it’s happening, rather than just having a nurse come in, check you and then they’re gone.”

Pickering enjoyed the help of community health nurses andCalogero and Perrault, who answered questions and alleviated her fears. Friends she made in the group sessions also helped.

“Nadia is one of my closest friends now,” Pickering says of a woman she met in the prenatal group. “Her son was born two weeks before Liam and we were going through the identical same thing. I just felt like I could call her and tell her exactly the kind of day I was having or what I was going through and she’d just be like, ‘Yup.'”

Husband Bill notes that the program is based on deep social roots.

“Generations ago there was always family around, tons of family and support. But now everybody’s so separated,” he says. “Anything that can kind of replace that somehow, that’s hugely beneficial.”

The program originally focused on South Vancouver because it has the city’s highest birthrate and the largest population of people who don’t speak English at home. It had the greatest number of babies with a low birth weight, a shortage of primary maternity care providers, an increasing incidence of Caesarean sections and fewer mothers breastfeeding. Focus groups held in the area revealed pregnant women did not feel they were getting enough information from their doctors.

The program provides service in 15 languages by recruiting doulas who speak Tagalog, Hindi, Spanish and others. It aims to serve 300 women per year. With increasing referrals from doctors and women asking for information based on word of mouth, the program averages one referral per day.

Referrals were slow at the beginning. Dr. Susan Harris, head of family practice at B.C. Women’s and one of the directors of the South Community Birth Program, believes doctors have been slow to direct patients to the program because they already deal with established programs or refer to doctors they know.

Dr. Thomas Gibson, who has practised in Marpole for 35 years, agrees. He stopped delivering babies about five years ago and says he usually refers patients to B.C. Women’s Family Practice Maternity Service, which provides care for women whose doctors don’t attend births.

“You probably get a bit more service at the South Community clinic. It’s just a pattern that I’ve established, that’s all,” he says.

He says obstetricians are “great,” but not all women need them.

“When the obstetricians do it, they all work in groups of six or eight or 10 and so you have a one in nine or 10 chance of having the doctor that you’ve gotten to know deliver you anyway,” he says. “I think it’s nice to have somebody that you’re pretty sure you’re going to know who’s doing your delivery when you’re there in the trenches.”

Midwife Linda Knox also notes some doctors have bad experiences with doulas who, instead of ensuring their clients have the information they need to make their own choices about pain medications and other medical procedures, interfere and try to “protect women from the system.”

But early statistics from the program seem encouraging. The program has already seen a reduction in the frequency of Caesareans and team members hope a study due next year will provide evidence the program is resulting in shorter hospital stays and a reduced need for medical intervention for women in the program.

Future funding could depend on such success. The provincial government and Vancouver Coastal Health each kicked in $250,000 for the program’s first three years. The money purchased computer hardware and software to keep updated files on each client and covers training for volunteer doulas and a $250 honorarium for each birth they attend.

Team members also hope the South Community Birth Program can become a model to other communities. Knox says similar programs could work well in rural communities, allowing overburdened caregivers to share caseloads, and the program directors recently talked about it at a national midwives conference.

Although the model may not be the answer for every community, women like Pickering and Dubb say it worked well for them.

“I just felt totally taken care of,” says Pickering. “Like I didn’t have to worry about a thing.”