Hopes and Fears

May 5, 2011 at 2:44 pm (Doula, Education)

At the beginning of the first class of my childbirth series, I give the parents in my class a questionnaire.  I ask about their impressions of pregnancy and birth, and their hopes and fears.  I love hearing what each person shares.  Is pregnancy exciting for them?  Scary?  Tiring?  Spiritual?  I also enjoy hearing about their fears.  If we can be honest about them, our fears can shine like a spotlight on areas where we need to focus.  If someone is afraid of a Cesarean, then we can explore that fear.  What would it look like?  What is the process?  Why might it happen?  What are the worst parts of it?  How could it be empowering/joyful?  By exploring fears, we find opportunites to turn disempowerment into choice and freedom, because we have the freedom to choose how we will meet any challenge that arises.  Fears can be tough to look at, but they allow us to do some really deep and powerful work.

I am also delighted to hear parents’ hopes.  At this class, we heard from the mamas first.  Their hopes resembled one another- hoping for a peaceful birth, a natural birth, a birth with lots of support.  Then, with a bit of prodding, the first dad shared his hopes.  One of them was that his wife would be able to “fully realize her potential as a woman.”  She giggled when he said that, and he blushed, but I was brought near to tears by the sincerity of his wish.  What a beautiful hope- that birth, this big, powerful unknown, would allow the woman you love to show herself in all her glory.  What an amazing love this young papa harbors for his wife, that he would want her to fulfill her potential.  This is the kind of love that is deepened by childbirth, and by the creation of a new family.  I’m excited to see this dad react to the awesome ability that I’m sure his wife will show when she gives birth.  And I’m looking forward to hearing him say, from that moment on, “You won’t believe how amazing my wife is.  She’s incredible.  She’s strong.  She brought new life into the world.”

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Questions to Ask Your Doctor or Midwife During Pregnancy

November 20, 2010 at 7:41 am (Doula, Education, Hospital Procedures, Informed Consent)

Your care provider and her or his philosophy about pregnancy and birth can shape the emotional tenor and physical experience of your labor and birth.  Ideally, you might want to interview three or four care providers before settling on one.  Here’s a short list of questions that you can ask providers- the answers will reveal something about both their practice and their personality, which can help you in making your decision.

If you already have a care provider, these questions can give you a sense of how your doctor or midwife likes to practice.  If her or his answers differ from your preferences, then you can begin a discussion to explore your options.  If there are any procedures that you would or wouldn’t like that are not in your care provider’s routine scope of care, you can request that whatever you’ve agreed on be noted in your chart, for future reference.  The information you glean from these questions is also helpful in constructing a birth plan.

Questions:

Do you have any recommendations for childbirth classes?

Are you likely to deliver my baby?  Can I meet your backup(s)?

What percentage of your patients deliver vaginally?  By Cesarean?

About how many patients out of 10 are induced?  How many go into labor naturally?

Have you worked with any doulas?  Are there any you could recommend for me?

What do you think of birth plans?

How long could I go with my amniotic sac broken before you’d want me in the hospital?

Do you do episiotomies?  If so, what would make you want to do one?

How often do you perform amniotomies (breaking the bag of water)?  Why do you do them?

How often do you perform cervical checks during labor?  What do you do if a client doesn’t want to be checked?

Are you comfortable with me eating and drinking during labor?

Are you comfortable with me walking and moving during labor?

How do you feel about natural, nondrugged labor?  Would you support me if I chose not to have an epidural?

Are you comfortable with me pushing in positions other than lying on my back or semi-sitting?

Will you deliver a baby in the water?

How do you manage the delivery of the placenta?

This is just a short list of questions.  You can find a more extensive list of questions here.  Remember that it’s not just what your care provider says when they answer your questions, but also how they answer, that’s important.  For instance, when asking about specific procedures, if your doctor says “Oh, all women in my practice…….”, then s/he might not have a lot of flexibility regarding your individual needs.  If your doctor is surprised that you would ask about unmedicated labor (“Why would you want to feel the pain?”), it might be a good time to question his/her belief in your body’s ability to give birth without intervention.  The best care providers are the ones who use their skill and knowledge appropriately, and balance the medical care they provide with the autonomous decision making of their clients.  You have the opportunity to find a care provider that fits well with your outlook and wishes.  Don’t hesitate to “shop around” until you find someone you feel really comfortable with!

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Doula Reverie

June 26, 2010 at 10:45 pm (Doula)

In a week or so, I’ll have reached my first anniversary of getting my doula certification, and like any anniversary, it has me feeling nostalgic. It’s been a lot of work, and not a little stress, to build a doula practice over these past three or so years, but the work has brought such beautiful insights and rewards. I’ve been thinking lately about why I doula, and what doulaing has meant for me. The thoughts have filled me with gratitude for this line of work, and I want to share some of them with you.

I feel honored by each of the women and their families who have invited me to join them during this expansive and yet intimate time. As I’m driving to each birth, I take some cleansing breaths and open myself up to the energy of the woman I’m about to help. I find the receptive place in my psyche and heart that allows me to intuit the most beneficial way to support this individual woman. And I give thanks for what I’m about to witness: the emergence of a new life and the expanse of a woman’s love and power as she brings that life into the world. Even in births that appear to be challenging, this gift of the joyful beginning is not lost, and I feel incredibly lucky to play a part in the dance that brings it to being.

When I began my work as a doula, I committed myself to being completely present to each woman’s unique experience, discarding all my own expectations and prior experiences so I could fully serve the families I work with. Each birth has presented me with opportunities to expand my awareness about what birth means. The first birth I attended involved a medical induction and an epidural, and the birth was as amazing and spiritually profound as any of my own home births. I learned that the physical components of the birth do not define the birth experience, that each birth is perfect in its own way. At another birth, I watched a baby emerge with his cord around his neck three times. With no interventions from the caregivers, the baby spiraled three times as he was being born, disengaging himself from his cord as he emerged. He showed me that babies know how to be born. Another mama had experienced a difficult back labor, and I watched her, as she approached full dilation, roll and squirm her body until her baby rotated, so that he could be born smoothly and easily. Mamas’ bodies also know what to do to facilitate birth. I was present for a challenging birth that ended in a cesarean, and I learned that as a doula, I can’t create a trouble-free birth, but I can support and validate a woman through difficult circumstances. And at the next birth, a simple and easy home birth, I got to witness a woman in her power as she gave birth on her own terms. I’ve seen mamas in recovery from drug addiction give birth without medication, and I’ve seen mamas who have accepted drugs with grace and dignity when they’ve been needed to facilitate their baby’s arrival. And I’ve learned that the Universe will provide me with what I need, from childcare to supportive friends and confidants, so that I can continue this work that I have been called to do. I feel confirmed in this path, and immeasurably blessed by the experiences I’ve had.

As I anticipate the growth of my doula career over the next year, I am happy, excited, and sure in my knowledge that this is what I am meant to do. The full moon is shining outside tonight, and it reminds me of all the big and beautiful pregnant bellies and the mamas and babies who I have the good fortune to accompany along their path to loving, joyful birth. I’m looking forward to watching my own three children grow, and witnessing the growth of the families who have welcomed me into their lives, as well. I can’t imagine a better career than being a servant of birth!

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Pain in Labor

May 3, 2010 at 3:18 pm (Comfort Measures, Doula, Education) (, , )

Lots of mamas ask me “What does labor feel like?”  “How much does it hurt?”  “Can I prepare for labor pain?”  Pain in labor, the big P word, can be a touchy subject to discuss prenatally.  Some doulas I know don’t use the word at all, instead mentioning “intensity”, “rushes,” and “waves.”  While I will definitely use the words “pain,” and “birth” in the same sentence, I also find myself qualifying it with many adjectives, to help modify the tenor of that charged word.  I do that for two reasons. 

First, not all women experience labor as pain.  In fact, some people even claim that any well-prepared woman will not feel the work of labor as pain, as long as she is sufficiently relaxed and not fearful.  Although I won’t go so far as to say that pain is not a part of labor for the majority of women, I am aware that expectations help to shape reality.  If, prenatally, a woman is not deluged with the expectation that her labor will be painful, then she might have a clearer mental and emotional path toward a pain-free labor.  So I, as  a birth professional, don’t want to shape a woman’s experience based on my own experiences- I want her to use her own words and feel things in her own way.

But what about the women who do experience labor as pain?  Are they done a disservice if the P word is never mentioned by well-meaning birth advocates before they enter into Labor Land?  I suspect that the vast majority of women I’ll encounter as a doula have already heard about many painful labors, and have a well-rooted idea of birth as painful.  So how can I help those mamas prepare prenatally for their coming birth?

Here’s what I tell mamas: For most women, birth is painful.  At the beginning, it is manageable.  At some point, it will reach a level of intensity that you may not have felt at any other time in your life.  But that pain is not the “something wrong” pain of an injury or illness.  It’s pain with a purpose- it teaches you how to move your body to best birth your baby, and it teaches you what an incredibly powerful, capable woman you are.  And there are things that can make the pain worse, and things that can make it more manageable.

The three most important things that have helped my birthing clients experience the sensations of birth with relative ease are: a quiet, safe environment, an attitude of acceptance, and the freedom to move.   And much of this can be cultivated and practiced before the actual birth.

A quiet environment helps a mama sink out of her neocortex, her thinking brain, and into her more instinctual mind.  She becomes less thought and more experience, less brain and more body.  If people don’t try to engage her by asking questions or chattering with each other, then the path to mental stillness is easier.  And this internal and external quietness has a big reward: endorphins.  Endorphins are the body’s natural pain relief, the internally produced morphine.  They are naturally produced when we go through painful or high intensity experiences.  They don’t always take away the pain of labor, but they soften the experience of it.  Endorphins can be counteracted by catecholamines, including adrenaline.  Adrenaline is produced when we start thinking a lot and becoming anxious, or when we feel that we need to defend ourselves.  So if a mama is made to talk and think, or if she is scared, nervous, or stressed out, she will not have as many benefits from her endorphins.  Prenatally, to encourage an endorphin-producing state, mama can do progressive relaxation exercises, prayer, or meditation.

The attitude of acceptance goes hand in hand with the quiet mental state, but it is a distinct thing.  Basically, it means allowing the birth process to happen, physically, mentally and emotionally.  It is an open state, non-resistant.  When a mama has this kind of attitude, then her labor energy can flow through her body without blockages.  And when she doesn’t resist the energy of labor, and yes, the pain as well, then she will feel less fear.  To cultivate this attitude of acceptance beforehand, a mama can practice saying some positive words or phrases in the shower, on the toilet (strange, I know, but it helps to associate the energy of opening on the toilet with the opening that will happen during birth), and in bed at night.  She could say things like, “I am open.” “I welcome this experience.” “I am joyful.” “Iam relaxed,” or any other positive statement that feels good.

Finally, position changes can do a lot to help mama navigate the pain and other sensations of labor.  Sometimes, one position (such as lying on the back) might feel intolerable, while another (such as standing and swaying) might feel doable.  This difference in sensation is teaching mama what positions are most helpful in opening her up and allowing labor to progress.  As labor goes further, it may get to a point where no position feels really good.  This is a great sign that labor is nearing the end, and it’s also time to listen to the body in a different way.   Sometimes, during transition and pushing, the positions that feel the most intense are the ones that are doing the most work.  So, at this point, a mama could choose a resting position, and allow her body to do all the work (a great choice at the end of a labor!), or she could choose an upright position where there is a lot more energy, and therefore more ability for mama to add extra power to the work her body is doing.  I remember this moment in my first birth, where I had been pushing though the first 2/3 of each contraction, and then resting as they eased off.  I finally got to the point where I realized that, if I wanted to see my baby any time soon, I’d have to find the strength to push beyond what I thought I could manage, to push all the way through the contraction and the pain.  And once I started doing that, I found more power and energy than I thought I possessed.  And I found that, even though the pain became more intense, there was also a great delight in feeling my baby finally move under my pubic bone, and very soon after that, into the world.  Once I stopped fearing the pain and trying to lessen it, and instead I stepped into the center of it and surrendered myself to it, I found that I could do more than I ever thought I could.  In this way, pain taught me not just how to labor, but also that I was capable of doing anything that I needed to do, and that I had more than enough strength and courage for the task of parenting my beautiful new baby.

So yes, for many women, there is pain during labor.  But it’s pain that you can work with, and it’s pain that will teach you a great deal about yourself, your body, and your potential.  As Pam England says in Birthing From Within, “Labor is hard.  It hurts.  And you can do it.”

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The Purpose and Value of Labor Support

May 23, 2009 at 2:46 pm (Comfort Measures, Doula, Informed Consent) (, , , , , )

Labor support is not a new concept.  Traditionally, a birthing mother’s female relatives and friends would gather to assist her through labor, birth and the postpartum, with or without the added assistance of a trained birth attendant.  Now, with an increasing number of extended families living great distances from one another, and with the demands and pressures of modern life and careers, that traditional support has been interrupted.  Women labor in the unfamiliar environment of hospitals, alone or with the support of a husband or partner who may have no prior experience with childbirth.  The creation of the professional doula’s role serves to address that lack of experienced, usually female, support that women used to provide for one another.

The birth doula’s role is to provide nonmedical support to mothers, families, and/or their friends throughout labor, birth, and the immediate postpartum. This support may take the form of physical comfort measures such as gentle massage, hand holding, positional support and recommendations, as well as many other techniques gleaned from modern and traditional sources.  Doulas also nurture their clients emotionally, providing encouragement and acceptance throughout the intense experience of labor.   Another part of the doula’s role is her advocacy for her clients.  Doulas meet with their clients prenatally and listen to their needs, values, and plans for their birth.  They assist their clients in gathering information about aspects of labor and birth that are important or of concern to the client.  During labor, a doula can help to facilitate communication with medical caregivers, and she can remind the mother of aspects of her birth plan or prenatal conversations.  This advocacy does not extend to speaking for the client, or to making decisions for her.  Doulas must be careful to shed all of their own values and standards of what constitutes a good birth, choosing instead to serve as a recorder and reminder of the mother’s decisions and needs.

The birth doula has responsibilities to the women and families she works with, her colleagues, the labor support profession and society in general.  “The doula’s primary responsibility is to her clients.” (DONA Code of Ethics)  She allows and encourages her clients to make their own decisions regarding their care.  She maintains their privacy and confidentiality, and does not spread information she has heard in client meetings to anyone else.  The doula strives to assist each mother who is seeking labor support in finding a doula.  She makes sure she is available to provide the care she has agreed to provide, and if she is unavailable, she makes sure to have a backup doula who can serve the client in her place.  She maintains reasonable fees which she clearly communicates to her clients, as well as the services provided for those fees.  With respect to her colleagues, the doula maintains a fair, reasonable, respectful relationship with them, and treats their clients with courtesy.  Doulas support their profession by maintaining its “values, ethics, knowledge and mission.” (ibid.)  When possible, she provides some clients with free or reduced cost services, to continue the “vision of ‘A Doula For Every Woman Who Wants One’” (ibid).  Finally, a doula commits to advocating for the health of women and children across society.

When birth doulas act according to their roles and responsibilities, the rewards to mothers and children are obvious and encouraging.  According to the findings of Hodnett’s et al meta analysis of 15 trials from North America, Europe and Africa, “Women cared for during labor by a birth doula, compared to those receiving usual care were

Cesarean sections have documented risks for mothers “including infections, hemorrhage, transfusion, injury to other organs, anesthesia complications, psychological complications, and a maternal mortality two to four times greater than that for a vaginal birth,” (http://www.childbirth.org/section/CSFact.html), and risks for babies, including “increas(ing) the risk to the infant of premature birth and respiratory distress syndrome, both of which are associated with multiple complications, intensive care and burdensome financial costs. Even for mature babies, the absence of labor increases the risk of breathing problems and other complications.” (ibid)  The decrease in cesarean birth for women accompanied by a doula in turn decreases the risks of these negative outcomes, and so therefore doula care has a positive effect on the health and wellbeing of laboring women and their newborns.

 An equally important consideration is the mother’s satisfaction with her birth experience.  Since mothers who have the help of a doula are less likely to remember their birth as a negative or traumatic event, they may be less likely to succumb to certain postpartum mood disorders, such as postpartum depression and post-traumatic stress disorder. 

These scientifically verified outcomes of labor assisted by a doula are encouraging in a country whose maternal and neonatal mortality rates rank among the worst in the developed world. “American babies are three times more likely to die in their first month as children born in Japan, and newborn mortality is 2.5 times higher in the United States than in Finland, Iceland or Norway, Save the Children researchers found.”  (http://www.cnn.com/2006/HEALTH/parenting/05/08/mothers.index/)  Doulas, with their information gathering and nurturing support, are well-placed to assist families in achieving a healthy, positive, and powerful birth, and therefore the best possible start for their life together as a family.

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My Doula Herb Garden

May 5, 2009 at 4:54 pm (Doula, Herbs) (, , )

St John's Wort

St John's Wort

This weekend I went to the Asheville Herb Festival with my daughter and our 9-year-old friend.  We spent  a happy hour wandering, looking at all sorts of green growing things, and talking about plant medicine.  I intended to pick up some staples for my garden, but I got drawn into the medicinal herb area.  As I spoke with the girls about how each herb can help women and mamas, I decided it was time to start my own doula herb garden.  Here’s what I chose:

Motherwort:  A pretty little plant with pink flowers, it promotes relaxation and helps to de-jangle mama nerves.  I used it after Stella was born, when caring for two rowdy boys and a brand-new baby girl pushed me right up to the edges of my coping abilities. 

Chamomile:  An all-around good herb to have in a garden.  Its flowers make a lovely and calming tea.  I mix it with red raspberry, alfalfa, and nettle to make a nurturing and nutritional brew for the mamas I know.  Chamomile tea is also great for a nursing mama (and as it goes through the milk, it helps to calm the babe), and it’s wonderful for young kids as well.  My boys love to drink it, and it tones down my eldest son’s energy when he’s wound up too tight.

Lavender:  Another calmative with a great scent.  Combined with other herbs, it makes a great sitz bath. I love lavender tea, and the dried flowers can fill a small stuffed animal or pillow for a new baby gift.  Lavender essential oil is also a great addition to a massage oil, for mamas or babies.

Comfrey:  A skin and tissue healer.  Comfrey is another good addition to a postpartum sitz bath, especially if mama has torn or had an episiotony.  Comfrey poultices or comfrey salves are great on scrapes, cuts, and sprains. And the fuzzy leaves are fun to rub:)

Blue Cohosh:  This one isn’t going in my doula bag, as its effects are stronger and need to be monitored by a midwife or doctor.  But I planted it anyway, in anticipation of the midwifery training I plan to embark on in a few years.  Blue Cohosh is a labor enhancer, and can sometimes be used to induce labor as well. 

I plan to include many more herbs as the summer goes on- I’ll let you know as I plant more gentle and helpful herbs!

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Reduce the Ring of Fire with St John’s Wort Oil

March 30, 2009 at 11:06 pm (Comfort Measures, Doula) ()

One of my favorite tips I received from an experienced midwife is a simple and effective way to ease the “ring of fire” some moms experience as their baby is crowning (as the widest part of the baby’s head is passing through the yoni).  She told me that she takes St. John’s Wort oil, a preparation of St. John’s Wort flowers in olive oil, and gently but thoroughly applies it to the perineum.  She told me that since she’d been using it, none of her clients had complained about the incredible burning, tearing, stinging pain of crowning.  Intrigued, I bought a jar of the oil for my second birth, and lo and behold, it worked!  I never felt his crowning in my perineum (although I was feeling the labor in every other part of my body…..unfortunately, I haven’t yet found a remedy for that), and he was the biggest of my babies, with a 14 3/4″ head. 

St John’s Wort is a well-used first aid remedy, because of its ability to ease nerve pain.  A description of its use, as well as many other helpful birth herbs, can be found here.  St John’s Wort can also be helpful when used in a massage oil if a mama is having painful back labor (since the nerves of the sacrum are frequently implicated in the pain of a posterior, or back, labor).  I usually carry a base massage oil, such as safflower, and then depending on the circumstances, I add  arnica oil (for tired, sore, bruised muscles) and/or St. John’s Wort Oil, and top it off with a few drops of lavender or rose oil.   If a mama is having nerve pain but would prefer not to use herbs, she can also try homeopathic Hypericum, which is the energetic form of the St. John’s Wort herb. 

As a doula who works in the hospital, I usually bring my oils with me, but I let my clients know that if they want them used during pushing, they will have to ask for them.  Doctors and midwives tend to be more likely to consider an herbal request from a mama than from a doula.  At a birth at a local community hospital, I was accompanying a mama who had expressed a strong desire to use St. John’s Wort during our pre-birth meetings.  When she started pushing, she said to her midwife, “I want that oil that Mayari has!  I want you to use it!”  Her midwife asked me what it was, and then shrugged and said “Why not?  Let’s see how it works!”  My lovely client, a first time mama, proceeded to push out her baby with no perineal pain at all, even though she (unfortunately) sustained a third-degree tear.  I was so pleased that the practitioners at this hospital were open to this gentle herbal assistance, and I have since found that many doctors, nurses and midwives are willing to try it if it’s what their patients want.

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Communitas in the childbearing continuum

March 1, 2009 at 5:11 am (Doula)

Communitas refers to “an intense community spirit, the feeling of great social equality, solidarity, and togetherness. Communitas is characteristic of people experiencing liminality together.” www.wikipedia.org/communitas   Doulaing incoporates much in the way of skills, information, techniques, and emotional integrity, but it is all held together by the spirit of communitas.  In the most liminal experience of a woman’s life, the bringing of a child from the shelter of the womb, through the threshold of birth and into the community of life, the support and solidarity of the people she draws around her can make the difference between experiencing birth as trauma and pain or experiencing it as a doorway into power as a woman and an actualized human being.  How can this sense of communitas be fostered throughout the childbearing continuum?

Prenatally, I meet with mothers at least twice and often more frequently.  Most of this meeting time is spent listening- listening to her needs, her wishes, her hopes, her fears, her plans for family and motherhood.  Listening to her partner, what he or she brings to the pregnancy and birth, where he or she would like support.  Listening on a more subtle level to the mother’s body, seeing how it responds to what she says and what others say around her.  How she interacts with her body and her baby.  Listening in complete stillness to see if the baby wants to communicate anything.  Only by listening can I learn how as a doula I can best support this family at this sensitive time.  After listening, I speak of what I hear from the family and what my own experience has been.  In this way, we share our stories, and in sharing stories, we create a common space where our brief community can flourish.

During the labor, communitas is fostered by trust, support and expectation.  I trust implicitly that every mama-baby unit will birth in the way that is best for them.  I trust that partners, family, friends or nurses will join the labor dance skillfully and will teach me to support this beautiful woman as I also teach them.  I support the birthing by respecting the mama’s own style of laboring, whether that be singing, moving, yelling, or silent concentration.  I support the birth space by limiting interruptions as much as possible and maintaining the energy of love and compassion throughout the birth time.  I expect that we as a birthing team will be incoporated into the caregivers’ routine with respect and courtesy, and that we will be able to negotiate the mama’s care smoothly and with equanimity.  I expect that the mother’s body and spirit will be honored.  When trust, support and expectation coincide in this way, our community can enhance and make sacred the birth, wherever and however it takes place.

After the birth, communitas continues.  We tell stories of the birth and recount the mother’s grace, strength, humor and bravery.  The new baby is welcomed into the world, and the love and camaraderie we have created amongst ourselves cradles her, as well.  I continue to visit the new family several times, watching with respect and amazement as they create their own beautful vision of what they will be.  And even when the visits are over, each family remains in my heart forever, each birth a strand in a web that connects me to the whole. 

Communitas- the spirit of community, the equal and complete participation of all members of a group, is the perfect description of how people come together to support a birthing mama-baby.  As a doula, my aspiration is to facilitate this support and watch a mother come into her highest power as she brings the miracle of a new child into our world.

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