Tips on Directing Your Care

All users of the healthcare system have a right to client-centred and directed care. This means that the relationship between “patient” and healthcare provider should be a partnership wherein the patient has all the information required to understand and make choices about their care that are aligned with their values and priorities. This relationship is based on trust, equality, and respect.

We’ve heard over and over again in the news that there’s a healthcare crisis. One of the many ways this crisis manifests is that the ideal of client-centred and directed care is increasingly difficult to attain.

In the case of medical care, standard appointments are 10 to 15 minutes. Anecdotally, I have heard that some physicians are so overwhelmed that they have begun double-booking patients in these timeslots. What I hear frequently from clients is that their appointments feel rushed, impersonal, and confusing. They often forget what they meant to ask or feel that there is no opportunity to raise questions or concerns.

While the pressures physicians are under are understandable, you deserve to have appointments that feel like they are about you. Here are some strategies that I have seen work wonders at shifting the focus of appointments away from routine care checklists and onto what matters most to you while preserving a positive relationship with your doctor.

Write your questions down

My birth and postpartum clients identify time constraints are the number one barrier to being able to effectively direct their care. When appointments feel rushed, we get flustered and forget things. With your questions written down in advance, you can let your physician know at the start of the appointment that you’d like to start with your questions, or reserve time for them at the end.

Keep Communication Open

At your first appointment with a new healthcare provider, find out their process for answering follow-up questions in between appointments. Some practices have a process for answering questions by email if you consent to this communication method.

Be knowledgable

There’s a stereotype that doctors hate it when patients come in with information they Googled. However, there’s a big difference between googling and landing on “Goop” or googling and landing on Evidence-Based Birth. I have had very constructive conversations with my healthcare providers when I have gone in with specific questions about how peer-reviewed research related to my diagnosis and treatment. Evidence-Based Birth is a non-profit founded and directed by Rebecca Dekker, an RN-PHD who summarizes academic research in language most people can understand.

Effective Questions

Know what’s in your healthcare provider's wheelhouse and keep your questions focused. Questions about the childbirth process, non-pharmacological labour management, or the social, emotional, and spiritual aspects of your birth planning process are better addressed in a childbirth education class, or with a birth doula.

When you are presented with medical choices, it can be helpful to ask your healthcare provider about things like mean (average) versus actual risk. For example, it is becoming increasingly common for an elective induction to be recommended at 39 weeks because this is associated with a lower probability (or average risk) of certain post-term complications. However, the actual risk of any of the complications occurring is very low. By knowing the statistics on the actual risk, you can make a more informed choice about the risks and benefits of your options. You should always ask about the benefits, risks, and alternatives of any proposed treatment.

Challenge Limiting Beliefs

Prior to the advent of the patient rights movement and patient-centred care philosophy, the dominant philosophy in medicine was paternalism. Both patients and physicians expected that “Doctor knows best”. Physicians gave directives rather than explaining options, and neither party expected questions to be asked for explanations to be volunteered. This mentality is still prevalent, and it hasn’t occurred to many people that it’s appropriate for them to ask their healthcare provider “why?”, or “What are the risks and benefits of this intervention?” or “Are there other options?” These are all questions that you not only have the right to ask, but that it’s important you have answers to. Feeling confused about why medical interventions were needed during childbirth, and feeling as though informed consent was not given is significantly correlated with birth trauma.

Creating a partnership relationship with your healthcare provider is a state of mind and might require some mental shifts for both patient and provider. In a climate of medical care scarcity, many people worry that if they ask too many questions or appear to be challenging the provider’s judgement, the healthcare provider will become angry and defensive, thereby worsening the quality of their care. While inevitably some will react this way, that’s not the norm and it’s more of a reflection on them than you. In my experience, many providers are open to having respectful health planning discussions, if you let them know you need to talk.

Reflections on Holocaust Remembrance Day &

Day of Remembrance and Action Against Islamophobia

Check out this blog post I wrote for Doula Canada

For as long as I can remember, I have loved to sing. Bursting into song has always been my instinct when I’m upset and I need to comfort myself. Even during some of my darkest hours, singing has always been a surefire way to lift my spirit, at least a little.

A growing body of research shows that I’m not alone. It’s not about talent either. Regardless of the quality of our singing voices, lifting our voices in song releases endorphins, dopamine, and oxytocin. This cocktail of feel-good hormones alleviates stress and reduces our perception of pain. Best of all, oxytocin is the primary hormone of birth, which produces uterine contractions that cause cervical dilation. We need to generate this hormone in very high levels for labour to progress to delivery, so giving our bodies a natural boost is always a great idea.

I sang to my son a lot while I was pregnant and after he was born. It didn’t occur to me that singing could be a tool during labour until I became a birth and postpartum doula. I certainly made a lot of noise, as most people do. Vocalization is a strategy that many people gravitate to when facing pain. The technique is more effective if the vocalizations are in control, relaxed, and rooted in deep breathing. Singing is a great way to produce vocalizations that have these elements.

It’s to be expected that there will come a time during labour when singing is simply not an option for the birthing person. Singing with a group of people regulates our mood and produces a sense of togetherness. When people are feeling the loving vibes of a group sing-along, they produce more - oxytocin! Maintaining positive, joyful energy through song is a great way for the birther's team to carry them through the transitional phase of labour and delivery.

The mood of a piece of music can have a direct impact on our own mood. So much so that during the Middle Ages, the word for musical scales, “modes”, and the word for our emotional states “moods”, were the same. We can leverage this to support the different states that are needed during labour. For example, at the onset of labour, soothing singing can be used to facilitate rest and relaxation. Consider the kind of music you might sing with baby, lullabies and mellow jazz standards. I used to sing this one to my kid all the time when he was a baby.

During the first phase of active labour, the goal is to support labour progress by moving around, changing position, and staying upright. Music to stay energized could be rousing spirituals, show tunes, or rocking out to Beyonce (I could see Formation, or Break My Soul being a good look here). “Bad Girls” by M.I.A. is another one of my go-tos when I need an empowering energy boost.

November 21, 2023

Loving All the World’s Children

An Intersectional reflection on Children’s Human Rights

CN: The War in Gaza

On Trans Day of Remembrance and World Child Day, I am reflecting hard on what it means to be a child at this conflictual time, and have one’s right to freedom and life be so highly contested. There is a war going on in the Middle East over land and the right to safety and self-determination. There is a war going on in my own backyard about how much control parents have a right to exert over their children’s access to information and choices. On the surface, these situations have nothing in common, and the violence in the Middle East is undoubtedly far more deadly. However, they have in common life-altering impacts on children. My philosophy of practice as a birth and postpartum doula is that opening my heart to all babies involves recognizing the interconnectedness of systems that cause children and families harm.

Fear and trauma are key themes in both battles. So-called parents' rights advocates are fueled by the boogeymen of drag queen groomers and trans bathroom predators. The month-long siege on Gaza that has claimed the lives of over 10, 000 civilians, almost 50% of them children, is fueled by intergenerational trauma, and the fear that acknowledging that Israel commits human rights violations and war crimes will result in millions of Jewish people being forcibly expelled from their homes, yet again.

Children’s lives should never become a battleground. When conflict arose on the playground when my son was small, we would always tell him that there was a non-violent way to solve his problems, even if the other kid started it. We explained that he could use his words to communicate that he was hurt and that he wanted the other person to stop their harmful behaviour. If that was ineffective, he could remove himself from the harmful situation and get help from a grown-up to solve the issue. We taught him that when we listen to each other and try to understand where the other person is coming from, there’s almost always a way to work it out.

As we look at the world right now, It’s painful to have to explain that this is not always the way the grown-ups in charge solve their problems. Sometimes they bully, lie, steal, and kill to get what they want.

As we add our voices to the global calls for human rights and an end to violence, we need to find a way to have the painful conversations locally. Our kids are watching as we argue about whether or not they can live their truth, and whether or not kids on the other side of the world can live. They are also watching a war in the Middle East devolve into acts of antisemitic and Islamophobic hate here in Toronto. This exposes them to some ugly truths about the pervasiveness of hate that is just waiting for a catalyst to erupt.

Our quotidien collective silence about hate is why the last month has been an eartly hell for millions of people. We can’t just start talking about complex issues when thousands of people start dying. By then it’s too late.

It may not be as obvious, but the move to make it impossible to teach about queer and trans identities in schools, and to force kids to stay in the closet is in service of hate. It makes the existence of trans people taboo, like a dirty secret. This dehumanization of trans lives makes it all the more possible for all kinds of violations and atrocities to happen in the margins and shadows. It’s dangerous.

We never want to teach kids to condone any sort of hate and we do want them to see and be grateful for their interconnectedness with all other living beings. When I was a little girl, we would sing this song in church about Christ loving all the children of the world. Yet in this same church, I was taught to hate and feel shame towards my queerness. I certainly didn’t feel included in the love that was being described.

You can’t claim to love all the world's children and then add a long list of exceptions. Being a doula from the heart means loving equally the kids in Gaza being held hostage and the kids having their limbs blown off. It means loving the awkward kid who’d get beaten up or get thrown out if their parents found out they felt more at ease using different pronouns and a new name at school. It means loving the kids who have more suffering even more fiercely. It means loving all kids as though they were our own.

Petition e-4652 before the House of Commons closes on November 24. The petition calls for the Canadian Government to:

1. Take a leading role in advocating for an immediate ceasefire in the Israel-Palestine conflict.

2. Support and actively engage in diplomatic efforts aimed at finding a peaceful and just resolution to this enduring conflict.

3. Advocate for the immediate termination of the Israeli siege of the Gaza Strip.

4. Encourage the entrance of humanitarian aid into the Gaza Strip through the Rafah Crossing.

Petitions with at least 500 signatures must be presented or tabled before the house, and a response to the petition be delivered within 45 days from presentation or tabling. It’s a fast, easy way to express your love for all the children of the world.

photo of Ike Kaja

August 1, 2023

Facing Violence with Knowledge and Understanding

CN: Gun violence, Murder, Opioid Crisis

In January of 2022, Ike Kaja a friend I had known for a few years became Toronto’s 11th murder victim of the year. He was shot in the head, in his car parked in his driveway in Forest Hill. The police have no information and the murder remains unsolved. No one who knows him knows why a kind, successful, unassuming man’s life ended in such horrific violence.

More recently, on July 7 of this year, a 44-year-old mother of two was gunned down by a stray bullet from a gunfight in broad daylight on Queen East, not far from where I live. This senseless killing has left the community shocked, saddened, and scared.

This awful tragedy has sparked a messy community debate. The shooting happened across the street from the local community health centre, which houses a Consumption & Treatment Service (CTS) where individuals with severe substance use disorders can access safer consumption, safer supply and other harm reduction resources. Since opiate users, including those who access the site, are blamed for neighbourhood nuisances (e.g. petty thievery,

property damage, street harassment) a minority of vocal community members have jumped to the conclusion that the CTS needs to be held accountable for the recent murder.

I think there is a connection between what happened to my friend, Karoline’s murder, and other recent random incidents of violence. However, I don’t believe it has anything to do with the placement or operations of CTSs.

On July 27, a Town Hall was held at Jimmie Simpson Community Centre, ostensibly to talk about gun violence. A panel of experts and stakeholders, including Councilor Paula Fletcher, MPP Julie Darbrusin, Chief Medical Officer of Public Health, Dr. Eileen Da Villa, and a superintendent with Toronto Police Services were present to answer community members’ questions. The identity of the event organizers was not elucidated, but over 400 residents showed up to discuss their concerns.

Ninety minutes of a two-hour town hall was devoted to questions that tacitly assumed the Site was responsible for what happened. Questions like whether the site’s most recent application review had happened according to 2018 vs 2020 protocols, why the CTS was near schools and daycares, what was being done to secure the perimeter and so on. At no point was any connection between the CTS and the shooting established, nor were questions regarding illegal guns raised.

Those of us who wanted to talk about violence and its causes were frustrated by the tacit assumption that the CTS was to blame and that moving it or changing how it operates would make us safer. Underlying these calls was the assumption that if the Site went away, drug use and its ills would go away.

The narrative that drug users and the people who furnish them with an unregulated supply are not from this community and that the CTS is drawing them to this nice family neighbourhood is a pretty gobsmacking rewrite of recent local history. The problems of poverty and other systemic marginalization have long plagued the neighbourhood. Gentrifiers are the new kids on the block.

Questions from the floor were taken during the last half hour of the meeting. During this time we learned that major crime in the area is lower since the Site opened. Gun violence is lower in this neighbourhood than in other Toronto areas. No neighbourhood is immune to violence, but in general, this neighbourhood is safe.

We also learned from the executive director of the community health centre where the harm reduction program is housed that the volume of mental health patients and the severity of their symptoms has increased dramatically during and post-pandemic. That’s what really accounts for rising random violence and it's the problem we need to focus on.

I’m working my way through the late Sinead O’Connor’s discography this week. As I write this, some lyrics from “Famine” (Universal Mother, 1994) jump out at me:

“See we're like a child that's been battered

Has to drive itself out of its head because it's frightened

Still feels all the painful feelings

But they lose contact with the memory

And this leads to massive self-destruction

Alcoholism, drug addiction

All desperate attempts at running

And in its worst form

Becomes actual killing

And if there ever is gonna be healing

There has to be remembering

And then grieving

So that there then can be forgiving

There has to be knowledge and understanding”

We can fix our problems together if we have the knowledge and understanding to remember that killers are made, not born. The violence that cut the lives of Karoline, Ike and so many others in this city short started long before their deaths. It breeds and festers when kids go to school hungry, abuse goes uninterrupted, when trauma and other illness goes untreated, and when people don’t have safe places to live.

Imagine the power of 400 neighbours in a room all talking about what we can do to make sure everyone has adequate housing, food, and health care, including mental health care. Imagine the innovation that could have been generated if we’d spent two hours on the right questions, like how are illegal guns making it into our city and what can be done to stop this? Would decriminalizing more drugs lead to a safer supply while stamping out a violent illegal trade?

I’m heartened by the energy and will in the room to achieve positive outcomes in relation to gun violence and harm reduction from this tragedy. Hopefully, we will have a chance to continue the conversation.

There are some constructive actions community members can take. Leslieville Harm Reduction Coalition was formed in the aftermath of the July 7 tragedy to mobilize community action in support of improving the breadth and accessibility of harm reduction services and reducing gun violence.

They have started a petition, which you can sign here.

If you have the funds, you can also donate to South Riverdale Community Health Centre Here.

From www.fayandfluffy.com

April 24, 2023

Drag Shows Have Always Been Family Shows

News recently broke that comedian and drag artist, Barry Humphries best known for his alter ego Dame Edna died at the age of 89. His death comes at a time when those with great fear of social change and the unknown have the energy to protest drag queens in colourful costumes and glitter reading stories to kids in libraries and other community venues.

What's especially curious about the outrage is that there isn't much social change here to be fearful of. Performers using drag as a form of clowning has been going on for hundreds of years.

The practice dates back to commedia dell'arte, the inception of theatre as we know it. Descendants of commedia dell'arte's stock characters, plots, and theatrical conventions can be found in all modern performing arts, including film.

At the inception of the practice, no one was trying to be "woke". Women could not perform publicly, so male performers would don a dress and make-up, a falsetto, and feminine mannerisms. The inevitably comedic results were leveraged for laughs in comedies, making drag a form of clowning in theatre since day one.

This has continued into the modern day in ways we are all familiar with. Dame Edna as already mentioned. Numerous Bugs Bunny cartoons where the "wascally wabbit" gets up as a blond with ringlets to seduce and mess with the hunter who's pursuing him. And of course, who can forget "Mrs. Doubtfire", a Robin Williams vehicle from the early 90s that was one of the first movies I was old enough to see on my own with friends. While Mrs. Doubtfire has not stood the test of time, no one batted an eye, no one thought kids were being sexualized, and no one thought "wokeness" (or ya know, the nefarious concept of social inclusion) had gone wild.

No one had a problem with drag around kids until it became seen as "a gay thing" and the right decided trans people were the real threat, over climate change. That's the real problem here. We've come a long way but the old, dangerous stereotypes about queer and trans people being sexual predators and therefore a danger to kids persist. We're also seeing the played-out and quite silly belief that queerness and transness are contagious.

This makes as much sense as thinking that everyone who watched Reading Rainbow with Levar Burton grew up to be a handsome, articulate, accomplished Black man. Wouldn't it be delightful if that was how it worked! What did happen is that a generation of kids of all races, including Black kids got to see that a Black man could be handsome, articulate, well-read, and accomplished. This was in stark contrast to what kids were being shown about Black men by most of the limited representation that existed at the time.

The same thing is happening now. In addition to engaging kids in books, Drag Queen Storytime teaches kids about the range of possibilities that exist with expressing their gender.

There could also be some legitimate confusion. Cirque Du Soleil and Ringling Brothers are both circuses, but the similarity ends there. Similarly, there's a huge diversity of drag shows, ranging from family-friendly to adults-only. I took my son to see our beloved local Drag Queen Storytime duo Fay & Fluffy many times when he was little. They are great storytellers and performers and the kids always had a blast. Their costumes were colourful, creative, glittery clownery at its finest, but definitely not sexy by any stretch of the imagination. Fay & Fluffy now host The Fabulous Show which celebrates diversity and inclusion and helps all kids to feel like there's a place for them in the world. What could be more wholesome than that?

April 12, 2023

Nailed It! Reflections on Becoming a Certified Doula

It's official! I'm a certified labour and postpartum doula.

This pathway to becoming a labour and postpartum doula has been a pleasantly unexpected transformative experience. While I have long been passionate about health equity I had honestly never considered engaging in client-facing health, wellness, or advocacy work. For over a decade, I have chosen to focus my career on the administration, research, and policy aspect of health care. Frankly, I had no intention of changing this.

Over the last year, applying my knowledge of the healthcare system, social determinants of health, research, and pregnancy and postpartum life to provide practical support to people in my community has been profoundly rewarding I couldn’t be more pleased that I stumbled into this work.

My labour and postpartum work with clients has been a great way to blend an eclectic mix of seemingly unrelated skills and interests. I have always been an "information junkie", which is why I decided to pursue a degree and career in health policy research. Applying my knowledge of research methods to support clients with specific research questions that arise during the pregnancy and postpartum journey has been a fantastic applied use of those skills. When working with clients, I have seen helping someone put their hands on the right information truly make a difference to families’ stress levels and confidence in navigating a challenging situation, which has been very rewarding.

The opportunity to become a doula arose at a time when I was also going through a significant spiritual transformation. Many of the insights and skills I have gained on this path have been helpful to my clients, most significantly in becoming a mindfulness practitioner. Mindfulness techniques have been a helpful tool for helping clients stay calm and focused during challenging or fast decision-making situations, as well as for pain management. Philosophies regarding impermanence, and approaching change with curiosity and openness have also been constructive tools for unpacking the need for the birth plan or intentions to change, both during prenatal planning and during birth. Applying mindfulness tools and teaching in my work with clients has been a wonderful way to stay resolved to practice these teachings in my own life.

Another wonderful and unexpected thing about my doula practice is that it has rekindled my first love for music and singing. Before pursuing my current career in health policy research, I studied to be an opera singer. After completing my master’s degree in music in 2009, I decided to go in a different direction with my life. Having the opportunity to sing with babies, and teach birthers how to use their voices effectively during labour has been a great way to refresh those skills and my connection to music.

I am inspired by the clients I have supported to advance my practice as a doula, alongside my “desk work” in health care. I am excited to see what the future of this path has in store and am looking forward to continuing my training in perinatal education and possibly other areas such as fertility support.

December 10, 2022

Final Certification Requirements

I am in the home stretch of my certification requirements at Doula Canada to be a labour/birth and postpartum doula!

2022 has been a whirlwind, but I am so grateful for the personal growth and accomplishments I have achieved.

After over a decade of "behind the scenes" work in healthcare, my work supporting birth and postpartum clients has been so rewarding. The opportunity to apply what I know about the healthcare system, social determinants of health and health equity to advocate for my clients and support the birth process that affirms who they are has been profound.

Right now, I'm focusing on the three book reports, and external credits I need to complete - and studying for the exam!

Stay tuned for updates in early 2023! I will be sharing the news far and wide when I am a certified doula!