February 2021

INTERVIEW

French Midwife Working In A Birth House

Knowledge is power

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Laurène, a midwife with physiological childbirth at heart

In today’s interview (and first ever made on Princess of Cups) I’m welcoming my twin sister, Laurène, a midwife working in a birth house near Strasbourg.

We will go over the process of a birth house delivery and exchange on the subject of birth based on her experiences.

You can watch the video of the interview (in french with english subtitles) or you can directly read the transcript below it.

(Ps: for the ones watching the video we had to cut two times because of technical issues so sorry about that!)

Interview transcript

– Today I’m interviewing my sister, because she’s a midwife working in a birth house near Srasbourg, I personally know everything about her but YOU don’t so please can you introduce yourself and your career path as a midwife

– Ok, let’s go! My name is Laurene, I started my midwife studies in 2012. Already during my studies I did internships oriented in what attracted me. I went to Guyane for 3 months and then I did part of my last year’s internship in Grasse that was oriented towards physiology. At the end of my studies fellow midwife friends convinced me to go to Mayotte. Without knowing it, I was given a job in a type of structure, that doesn’t exist on the main Island of France, ran only by midwives, not doctors. And once I came back to France I wanted to be liberal, which I did for a while in Paris, and then an opportunity presented itself to work at Manala: the birth house I’m working at today.

– It was kind of your dream, the birth house, you already talked about creating one in the future

– I talked about it a lot during my studies, I was always dreaming about this birth houses ran by a midwifes. With all my midwife friends, who have the same mindset as me, we dreamt about opening a birth house together one day, but turns out I didn’t have to, I simply joined one.

– So in the end you experimented both the hospital environment versus birth house, I think we can say you are 100% pro birth house. But can you tell us a bit about why, and your opinion on hospitals VS birth houses, the advantages and inconveniences between the two

– Well, to me,  I only experienced the traditional hospital structure during my studies. As a student you don’t have the same position as when you are a certified midwife. At first you just follow the movement but the more I was learning and evolving, the more it didn’t make sense to me what I saw in the hospital.

– Is it hospitals in general or more the case only in certain hospitals?

– There are huge gaps between maternity wards, some have a general orientation towards physiology and the respect of the babies, but as soon as you are in larger structures more oriented towards pathologies you’re not in a frame that favours a “respected” birth I would say.

– Have you been in a clinic as a compared to the hospital?

– Yes, only one internship, I then had feedback from my patients who delivered in a clinic. It’s something different than the hospital because the patients have a special connection with their gynaecologist. But I went towards the birth houses because that’s how I envisioned my job as a midwife: accompanying the woman and the couple during their pregnancy. Respecting that process and having the means to respect that process. One of the big problems with the maternity wards in France, is that, because of economic problems, there are very few midwives actually on the same shift. So the less midwives you have the less you can take care of a person in labor. It’s common for one midwife to take care of 3 or sometimes even 4 women in labor. So in that instance it’s impossible to take proper care of any of them.

– You also don’t always see the delivery through, since you have a working schedule

– Yes, it’s a system where the woman who comes to deliver maybe she’s going to spend 10h with a midwife, and if it’s the end of her shift, she’ll finish the rest with another midwife. It can be disruptive to some, yet there are others that have a high capacity to adapt so it doesn’t bother them. At the hospital there is a system that doesn’t allow the midwives to do their work properly. There are too many things to do.

– They are limited

– Yes not enough time, we do things quickly without having the time to talk to the woman, once the delivery is done, there is a ton of paperwork to do that takes a lot of time. So, yeah, I didn’t really like the hospital environment. It’s a very sterile place. All the material is right there in plain sight.

– Not really cosy… So I think people are pretty familiar with the concept of hospital deliveries, but concretely how does a delivery in a birth house look like?

– For a delivery in a birth house, the women contact the midwife right at the beginning of their pregnancy. So they are going to be followed by that midwife all throughout the pregnancy. Here in Manala, we work in trio, so a woman is going to be in touch with three of us during her pregnancy and at least one of these 3 midwives will be there during the delivery. It’s what we call a “global following” so she sees different people but always the same ones: before, during and after in post-partum. There are home visits, we provide breastfeeding support, a lot of woman at Manala decide to breastfeed, but it’s not always the case so we accompany them with the bottle as well, also the perineum rehabilitation etc. It will be the same midwife taking care of that. On the day of delivery, when they think they are in labor, they contact the midwife on call. We meet in Manala, she chooses the bedroom she wants. The bedrooms basically look like the one you would have at home, except for the big tub in the middle. Once she delivers she stays a minimum of 4 hours to check that she’s recovering well and have energy, that the baby is eating well etc. Since they return at home really fast we have to make sure the baby can eat correctly. But, of course, if the 4 hours are at 2am we don’t send them back home! But they go home very fast and then all the postpartum care are done in their home.

– All right, so you’ve been in liberal for quite some time and now at Manala you do the pre birth and after birth care, so do you have recurring worries or prejudice regarding the birth?  Are there things that really worry future mothers?

– Globally, for almost 100% of women, that they are pregnant or not, there is a representation around birth that it’s scary or dangerous. So we need to work on that regularly. They are scared of “what if something goes wrong?” But why would it go wrong? So you have to remind them that the delivery is a physiological process imprinted in their body. What I often tell them is that they ALREADY know how to give birth, that I’m going to give them information, but even if I didn’t, they would still know how to deliver their baby. There is this loss of knowledge around birth, we used to have a lot of tales from woman delivering at home, sometimes even alone. But now the representation is that we need help to give birth, we need a doctor or a midwife to deliver. Sometimes it is the case, you can’t tell that everything is perfect in the best of world, but in the majority of cases things go well. So we need to re-teach women to trust themselves and their capacity to deliver. As well as trust their babies ability of bringing themselves to life.

– So a lot fo psychological blockages

– There’s also of course the subject of pain. Women who come to Manala know very well there will not be medical pain management in place, it’s a decision they are aware of making. So there is a preparation around that as well, talking about the hormones that reduce pain, positions that reduce pain and so on. But it’s true that it’s often psychological blockages as you say. There are very few physical reasons that could make it go wrong, really.

– Our body is made for it

– Also, by working in Guyane and Mayotte, women there are not much impregnated with our culture, they have no birth preparation with midwives whatsoever and they gave birth very well. Because for them it’s like that.

– It’s innate.

– Yes it is, they still come to the maternity because they know it can be safer to deliver there. The feeling of security is very important, that’s why I don’t insist if a woman tell me “I have a project of delivering in a physiological way but the birth house, I don’t know… what if something goes wrong, I would feel safer at the maternity” well that’s fine they can go to the maternity ward. They might deliver just as well as at Manala there.

– So it’s a matter of the place we feel most secure that’s important. But I feel like in a way, a lot of women have this false sense of security in the hospital, the culture and mentality makes us feel like this is where we will be the safest.

– Yes, that’s what I talked about earlier, there is this fear around birth that has been taught

– Yes, it’s became a very medicalized process, especially in France

– There are countries where it’s far less medicalized with a much lower rate of epidural, here we are around 80%

– That’s huge

– Yes it’s really high

 – I feel like it’s seen as this “miraculous” solution to pain, but it’s still a medical procedure, and you could probably confirm there are risks to do it, and it’s not miraculous

– All medical procedure have risks, it’s like every surgery there isn’t 0% risk. There could be complications on an epidural, they are very low now because it’s been perfected. But yes there are risks, more commonly the issue is when they aren’t “perfect”. A perfect epidural is where you don’t feel the pain of the contraction but you still feel it, while keeping mobility and sensations in legs and the waist. But sometimes you can’t have those 3 criteria together. Sometimes the epidural works only on one side, so you still feel pain and are without mobility, so you don’t have the advantages and you have the inconvenient. Or what happens often is that the epidural works too much, so the woman doesn’t feel anything, she can’t move her legs, she doesn’t feel her contractions has no sensation in the waist. And this , my opinion, will induce complications and medicalisation. Epidurals aren’t something minor and once you come and affect something that is physiological and go against it there are always consequences. So what I tell women is that they have to have these information, and then weigh the pro and cons, if to them there are more advantages to not feel the pain, well yes take the epidural. But now if to them it’s more important mobility and harmonious labor, well it’s best not to have it. But that’s a very personal decision and I always supporte women in their decision, it’s not my delivery so I’m not here to tell them how to have theirs.

– Talking about pain, we often hear from natural birth that women say it’s like they were in a “trance”, is this true? Is it something you feel during the deliveries?

– Oh yes completely! There are different phases in the delivery and when the woman is in a more active part of the labor, she will have hormones that flows with abundance like oxytocin. It’s the hormone that will give the contractions, but that is also secreted in all situation where we feel love and happiness in our lives. There are also endorphins that will reduce the pain, like a natural morphine. So women when they are in this phase, they are somewhere else. Each describe it in their own way, some will describe it as “another world” others say they were in a “bubble” for exemple.

– It’s not described as something horrible, this period of intense contraction that is feared isn’t necessary difficult to go through.

– Well the experience around pain is subjective from one woman to another. But in general the women chose to do this path without epidural so they are prepared for this pain, not like something you need to reject or runaway from, but as something to accept that is going to lead us to the end result: the baby. It’s really a mental preparation.

– So you’re saying it’s something psychological

– Yes, women who chose to come here have all the preparation for the birth, it’s a work done with the midwives but also everyday at home by themselves. Most of them won’t say there isn’t pain, not at all, they will often say there was difficult times, but they overcame it and got to that trance moment. All of them retain something different from the experience, but no they don’t experience it as something horrible.

But it’s not because your are at the birth house that you have to stay during the entire labor without epidural. Women should not come with that objective of never doing an epidural and risk having a bad experience because of it. The idea is that they are happy with their delivery, the way their baby is born, and if it’s with an epidural at the maternity next door that’s fine. But most of them have a beautiful memory of their delivery, they describe it as beautiful, magic etc They would say “It was difficult but ooh lalala it was magical”.

Some are so filled with hormones they don’t describe it at painful, some would have some amnesia. Some won’t remember what they said during the delivery, or some say “it’s weird I remember saying that but I don’t know why I said that”. But they are very happy about their delivery, they are proud of all the resources they had and delivering by themselves. And that also reinforces the feeling of skill, they knew how to birth their baby so they will know how to take care of him. So that’s also positive for that.

– So as of today how many birth houses is there in France?

– There are 8 on all the French territory so also in the DOMTOM

– Are there also these types of platforms in other countries?

– Yes there is many, we are very late in France! For example just right next to us In Germany, there are around 200 or something like that, we are really late. England, all the nordic countries and so on. But it’s coming here too, it’s going to grow, now we’ve passed the trial period and others are going to be created. So far about 12 new ones are planned so there are projects all over France being built. And I think it’s going to continue that way because it’s simply a demand from couples, it’s what they want so we are responding to that demand. The objective is then to go towards a facilitation of  home birth , but one thing at a time

– Yes that would be revolutionary here

– It’s going in that direction but it’s true that midwives doing home births are seen in the medical world as witches doing crazy things and endangering women.

– Well in France

– Yes totally! Whereas elsewhere that’s not the case!

– So as a midwife do you sometime wish you where in another country?

– Certainly, it would be easier, especially if you are in an “alternative” field but no I don’t want to leave, because I don’t know… I feel it’s my mission to make things evolve, to make this transition towards respected births.

– It’s weird because we are so different in some ways but we really agree on this matter, even in my attraction to maternity and starting maternity photography, it’s something that attracts and impassions me even though I couldn’t picture myself being a midwife. But it’s weird we feel the same way about it, I mean we didn’t experience delivery yet but it’s very interesting. And we find ourselves surrounded with many people who feel the same way, it feels like there is this awakening happening. So let’s conclude on this last question cause we’ve been talking forever already… If you have resources or things you advise to future parents/parents, like are there associations, etc?

– For which type of parents? Because I will orient them to the right direction. If it’s a couple from Manala there are already resources from the association, because we aren’t just a birth house we have an associative life, (well now not really with covid) but couple can simply do research, a lot of people don’t know about birth houses or that there might be one near them. I would say that alternatives do exist, there are a lot fo resources on the internet. There are a lot of books I recommend that I even use to inform myself like all the ones from Michel Odent, there’s Ina May Gaskin or “what to do about pain” from Maité Trelau

– Yes it’s not really an approach that is mainstream in France so they don’t really teach you all that in midwifery school right?

– No, not really

– So you had to educate yourself

– Educate yourself alone, do trainings etc

– So you would recommend to couples that they get resources directly from their midwife?

– Every midwife has a professional orientation that will make her know specific subjects. They can go towards parents associations, birth houses etc But if they contact a midwife they will have more time for exchange compared to the traditional hospital or doctor appointments

– So before anything it will be important to ask ourselves what kind of delivery attracts us, do we feel intrigued by a more physiological approach and then go to the practitioner that will correspond

– They can even think about it before a pregnancy. If it’s something close to their hearts they can do researche, but nobody really wants to have to search and dig for these information, we want them to be easily accessible and already known. Midwives also do pre-conception consultations, if you have a project of pregnancy you can get an appointment and start talking about it. Now we have a long appointment that is “mandatory” here, to talk around pregnancy, about each parent, the birth project and we will orient them toward the right place. But it’s also the parent’s job to do their own research

– Yes because unfortunately these subjects are still marginalized, at least here in France, even though things are changing

– I have more and more women coming to me who says they have a physiological project or are curious and open to different options. I see a real shift already since my studies.

– There is a real awakening

– Yes that corresponds to a general awakening in society, women can give birth physiologically anywhere but it’s best in a favorable environment with people we know and that we trust, some women will have crazy resources and will be able to deliver anywhere

 . Do you have a last message for parents. Future parents

– Trust yourself?

– Yes I love it! Trust yourself!

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