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Category Archives: Birth

Doulas as pacers

Truth?  Sometimes I’m baffled by my work as a doula.  I’m confused by the mystery that my presence makes an impact.  Especially when I don’t *do* anything.

Take Julia’s birth.  I left Julia’s birth feeling like her three year old did more than I did.  I mean, really.  What did I possibly offer to that family?  And then later, Julia’s husband says I was worth every penny.

It made no sense.

Or Melissa’s birth.  I fanned her.  With a manilla folder.  That’s about all I did.  And then later, she says she couldn’t have done it without me.

It made no sense.

I read about the early studies on doula support.  In those double-blind randomized controlled trials, the laboring women had no idea that the extra woman in the room was a doula.  They’d never met before.  Yet, their birth outcomes were significantly better than the births that did not get the “extra person.”

It made no sense.

Nearly 8 years into this gig, I think I’m maybe beginning to understand how doulas work.

We’re pacers.

I’m reading an incredible book titled The Worst Is Over:  What to Say When Every Moment Counts.  I bought the book thinking it would help with my kids.  Norah has an anxious tummy and Cedar is ever catapulting from high places.  I never imagined how it might relate to my birth work.  But, of course, women in childbirth are in an altered state of consciousness just like people who experience trauma.  Childbirth is NOT trauma and not always even painful but the brain does go into an altered state.  Women in childbirth are often dreamy, time becomes hazy, thoughts may be confusing, suggestions plant deeply.  I already knew how important language is for birthing women but this book took it up 10 notches.  And it taught me about pacers.

So what’s a pacer?

You know how you modify your body language, voice, words to become more in sync with others?  It’s a normal part of communication.  Or sometimes a strong personality can change the entire mood of the room when that person is having a bad day.  The author describes pacing as “our natural human tendency to tune in to others nearby by matching our words and our behaviors to theirs.”

The author talks about the importance of pacers when people are afraid, hurting, in shock, etc.  Pacing builds confidence, healing, comfort, rapport, and cooperation.

supportHow does this work in childbirth?

Nancy is deep in the birth zone.  She is in an altered state of consciousness.  She is barefoot in the hospital shower–a state that would disturb her any other time.  Usually a very modest woman, Nancy is naked.  Her husband, in swim trunks, supports her physically in the shower.  What am I doing?  I’m leaning against the wall, offering a sip of water from time to time.  I don’t say a word.  But here is the non-verbal pacing that is happening:  Nancy locks eyes with me as she welcomes each surge.  My eyes are confident, grounded, and full of love.  She knows I’ve done this before.  My eyes tell her everything is normal.  What else?  My posture is relaxed.  I’m not carrying tension or shedding adrenaline.  As we lock eyes, I take a deep cleansing breath and release it slowly.  She mimics me.  I smile.

IMG_2632Sarah sits on her birthing ball leaning on her king-sized bed.  Her husband rubs her back.  Bon Iver plays in the background and the rain is falling outside.  There is nothing for me to do so I sit in the corner and knit.  Sometimes, Sarah looks over at me and I smile.  My calm, slow knitting reassures her that all is progressing perfectly and there is no rush.

Heather’s labor is showing signs that baby is not in an optimal position.  I show her a technique to lunge during her waves.  Her husband stands behind her providing extra support.  I stand in front of her and lunge with her.  We are exactly in sync as we lunge and lunge and lunge some more.

What makes doulas uniquely suited for pacing?

The doula’s focus is entirely on the mom.  Midwives are amazing pacers but they sometimes have other important tasks that may come first or interrupt:  monitoring baby, checking mom’s blood pressure, etc.  Particularly in those rare cases of emergency, it is vital to have a pacer who can remain focused on mom.

Dads, close friends, family members are not always the best pacers.  Why?  They’re emotionally caught up with the experience.  They should be!  I remember catching a glimpse of my mother’s concerned face at my first birth.  It did not reassure me.  Sometimes dad isn’t sure if what his wife is feeling is normal and his face can mirror it.  And the birthing mom’s spidey senses can smell fear and uncertainty.

Giving name to this intuitive process has helped to deepen my understanding of what seems so mysterious–how the presence of a doula-who-does-nothing can be enriching and often crucial to the birth.

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A First Time Family’s Homebirth Story

I have a new birth story available for your reading pleasure. Tori and Eric were such a pleasure to have in my Hypnobabies class. They were nearly giddy about all things related to their birth.

I’m happy to share their birth story here.

You can also catch them in person at July’s Blessingway. They will be sharing their birth story with our community at 2pm on July 27 at Natural Baby. The event is free and open to everyone!

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New Birth Story

I am excited to share Moira’s birth story!  Moira experienced a completely comfortable birth using Hypnobabies.  I’ve never seen doctors and nurses behave the way they did at her birth.  She refused to be checked for dilation and she was so relaxed that her care providers didn’t believe she was very far along.  I had to physically go find a nurse (twice–she didn’t come the first time) because the baby was almost born!  Moira had the Hypnobabies sign on her hospital door and once everyone realized that she really was about to give birth, curious nurses quietly filed in to watch.  The doctor waited for the placenta to deliver before clamping the cord.  Later the doctor told me, “I just got caught up in the physiological process!”

Enjoy!

 

April is Cesarean Awareness Month

Many bloggers have written incredible posts about the shocking cesarean rate, VBAC support, and resources for healing.

I’m not going to try to repeat what they have already so eloquently written.

I want to talk about the idea of family-centered cesarean birth.

I don’t attend many cesareans.  The ones I’ve attended lately are so vastly different from the ones 5 or 6 years ago.  Those involved babies sent to nurseries while mom was in recovery–sometimes alone.  Waiting family members snapped pictures of this new life while mom caught only a quick glimpse in the operating room.

Now, I witness something astoundingly different.  It is much more common to witness births in the operating room involving skin-to-skin contact, sometimes delayed cord clamping, moms with arms unstrapped, and recovery together as a family.  Baby is often held skin-to-skin with dad when not on mom’s chest.  Doulas are more frequently allowed to accompany the family for the cesarean.

Recently, one of my couples experienced a cesarean birth.  After pushing for hours in every position imaginable, their posterior baby (with a 15 inch head, mind you!) was born by cesarean.  Their medical team gave us all the time we needed to try every trick I knew.  The couple was disappointed but they remained empowered throughout their birth experience.

They won’t be showing up for the 18 month cry.

I want to share a few of the pictures from their cesarean birth.  The obstetrician called in to perform the cesarean was Dr. Danielle Harris.  She immediately agreed to their wishes for delayed cord clamping and skin-to-skin.  The family physician who had supported them through the birth was Dr. Keith Stafford.  You know him on this blog as Dr. Polo Shirt.

Dr. Harris hands baby to Dr. Stafford who places him directly onto mom’s chest.  He doesn’t dry the baby first or take a detour to the warmer first.

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Dad steps in to help mom hold their son.  Mom’s arm is free to touch her baby.

Here’s hoping that more babies who must be born by cesarean will experience a gentle welcome like this one.

Huge thanks to my clients for permitting me to share a little of their birth experience.

April is a happening month

Just a sampling of some local events:

April 6:  Movie Day at the Hughes Main Library.  Watch “Born in the USA” and learn about birth choice in SC.  I’ll represent the doula perspective on the Q&A panel after the event.  10.00 donation suggested.

April 8:  The Spartanburg Babywearing Group meets at Labors of Love.  11am

April 10:  Greenville Cloth Diaper Group has a monthly meeting at the Taylors branch library.  10am.

April 11:  EarthFest at Greenville Tech’s Barton Campus.  I’ll be there working a table for Upstate BirthNetwork.  Stop by and say hello between 10am-2pm!

April 11:  Prenatal Yoga at I Love Natural Baby.  5pm

April 12:  Parent and Toddler Yoga at I Love Natural Baby.  10am

April 12:  Parent and Baby Yoga at I Love Natural Baby.  10:45am.

April 13:  Come hear the sexy-voiced Michel Odent, MD speak about birth.  Sponsored by the Bellies to Babies Foundation and the SC Birth Coalition.  Info here.

April 13:  Cloth Diaper 101.  A free class to introduce you to cloth diapers!

April 15:  La Leche League of Greenville meets at I Love Natural Baby.  7pm.  Other meetings throughout the upstate.  Check http://www.llli.org to find the meeting closest to you!

April 20:  Thrive:  A Conscious Health Experience in Clemson.  Looks like such a fun day full of exhibits, kids yoga, and special speakers.  10am-4pm.

April 20:  The Great Cloth Diaper Change is happening at I Love Natural Baby.  Come break the record with your baby!

April 23:  Meet the Midwives event at Greenville Midwifery Care.  6-8pm.  Registration is online through our home page on website or you can email to GMCmidwife@ghs.org.

April 27:  Blessingways:  A Gathering of New and Expectant Families.  April is Cesarean Awareness Month.  Join the discussion.  2pm.

April 28:  The Fair Exchange.  This is the third year that I’ve organized this amazing event to raise $$ for a cause.  This year, we’re raising money for the SC Birth Coalition as they lobby to protect birth choices in SC.  Stop by and shop gently used baby clothes, cloth diapers, babywearing products, etc and buy some raffle tickets for fantastic prizes.

This month, I’m teaching three Hypnobabies series and will attend two births, two postpartums, three prenatals, and meet with a few new couples for the first time.

I thought this was a part time job?  I love it so.

Extraordinary Nurses

Many families worry about which nurse they will get during their birth.  The nurse is a wildcard.  We can pick our midwife or doctor.  We can pick our doula, our birth photographer, our childbirth educator.  We can pick our hospital.  We don’t get a choice in our nurse(s).

I’m so happy that nearly all the nurses I’ve worked with in the last few years have been amazing.  Occasionally, one nurse really stands out and shapes the birth in extraordinary ways.  Like Beth two years ago.

This time, I’m bragging on Mona.  I adore Mona at Greer Hospital.  She’s been a rockstar for many of my clients.  Mona played a big role in this birth.   And she caught the baby before Dr. Polo Shirt could arrive at this birth.

So I knew I could relax when I saw Mona walk into the birthing room.

monaWhat made her support so extraordinary at this birth?

  • She kept interactions with the mama at an absolute minimum.  Mama stayed in the tub and the door to the bathroom remained closed 99% of the time.
  • She used a handheld doppler for quick listens to the baby’s heartrate while mom was in the tub.  She also used a handheld monitor while mom was pushing.  My client didn’t have anything strapped around her belly.
  • She ran interference when the doctor preferred that the mom get out of the tub sooner rather than later.
  • She stalled when another nurse prompted that the mom needed a hep-lock.  The mama never did get that hep-lock.
  • She applied hot compresses on mom’s perineum when baby was crowning.
  • She patiently and quietly guided this first-time mom and then called the doctor in a few minutes before the baby was born.
  • After the birth, she didn’t fuss with the baby or try to talk to the mother.  She stepped back.  After an hour, she still didn’t fuss with the baby or suggest taking her.  In fact, when I left, mama was breastfeeding her baby and blissfully devouring her own lunch tray.

I love this nurse.  She is a strong and quiet presence.  If you give birth at Greer Memorial and Mona walks into the room, relax.  You’re in very good hands.

(Also, I hope she doesn’t kill me for blogging about her!)

SC Lay Midwife Act–Bill 3731

You may have heard that SC is going backwards again.  Not surprising, really.  But for a conservative state, I’m surprised at the movements lately to squeeze in more governmental control.

Enter Bill 3731, the SC Lay Midwife Act.

What the heck is a “lay midwife?”

I’ve attended over 100 births as a doula.  If I decided, “Hey, I think I know a decent bit about childbirth.  Why do the OBs and midwives get paid the big bucks?  I think I’ll start catching the babies.”  That.  That would be a lay midwife.  I would be a person without training hanging up my shingle. (*see footnote)

When I first read this bill, I thought the legislature’s intention was to criminalize, well, lay midwives (i.e. people who were DIY babycatching).

Surely they could not mean SC Licensed Midwives.

Then I read on.

Now, I realize it may be difficult for a layperson (pun intended) to understand the in’s and out’s of midwifery with it’s many acronyms and differences state-to-state.  Let me break it down.

To apply the misnomer “lay midwife” to our licensed midwives is offensive.  Simply that.  And clearly the bill understands this offense as it belittles midwives and the families they serve by requiring a name tag (!):  A lay midwife shall wear a clearly legible identification badge or other adornment at least one inch by three inches in size bearing the lay midwife’s name and the words ‘Lay Midwife.

Do you see the absurdity of this?  These midwives are attending births primarily in homes.  They have spent hours with the families they serve prior to the birth.  Name tag?

Back to this lay midwife term.  The bill defines lay midwife as a “midwife who may have had little formal training or recognized professional education in midwifery, who learned by accompanying doctors or midwives attending home births.”

Does that apply to SC Licensed Midwives?  In the 1930’s, the state embarked on formal training of midwives.  There were thousands of midwives practicing in rural areas, equipped by the SC government.  In the 1970’s, a move (eerily similar to this one) ended government support of midwives.  The people of SC reacted in protest and a new licensure program developed in the early 1980’s.  This licensing process is still in place and ain’t broken.  DHEC sets standards and regulations for midwives.  Their outcomes are public information.  Nobody is hiding anything.

A layperson can go to the DHEC website to view more information than s/he would ever want to know about regulations, current care providers, reporting, and more.

“Little formal training?”  Licensed midwives must complete a formal education program approved by DHEC and finish an intensive clinical apprenticeship.  Typically the preceptor-apprenticeship ratio is 1:1 or 1:2.  It cannot be more than 1:3. The apprenticeship generally takes 2-3 years.  Then the applicant completes an examination.  Once licensed, there are continuing education requirements and peer review processes.  And, of course, there are fees, fees, fees.

Calling Licensed Midwives “lay” would be the equivalent of suddenly calling all Licensed Builders in the state “lay” and requiring citizens to hire structural engineers to build their deck.

This bill will end the licensing of midwives in SC.  It calls for direct supervision of “lay midwives” by obstetricians.  Obstetricians and licensed midwives practice in different environments and under vastly different models of care.  Don’t let the wording fool you, this bill would end legal midwifery for out of hospital birth in SC.  This supervision wording is merely a smokescreen.

What will happen if there are no licensed midwives in SC?  There will always be families who don’t want a medical birth.  There will always be families who choose homebirth.  And there will, I trust, always be midwives who will serve them.  But these midwives will do so under the threat of criminalization.

There are many other issues associated with this bill:

  • Financial considerations:  a homebirth with a licensed midwife typically costs less than 4000.  An uncomplicated vaginal birth at the hospital may cost 10,000.  Medicaid reimburses licensed midwives.
  • Freedom:  this bill removes access to professional midwives.  It will destroy an entire profession in our state; a profession recognized world-wide.  If you care about freedom, this bill is one to fight.
  • Safety:  I would need to write an entire post to discuss this one!  This bill is not about the safety of mothers and babies.

So now, what will you do dear layperson?  I saw a few weeks ago how a rapid response from citizens pressured the sponsors of a homeschool bill to remove their support.  We can make that happen here, too.

Keep up to date on talking points, petitions, and information at the SC Friends of Midwives website.

Write, email, call the members of the 3M committee.  Let them know you  oppose this bill.  You don’t need to write or say anything fancy.  I think numbers are more important at this stage.

Please help SC families who want access to licensed midwives and protect our freedom to choose where and with whom to birth.

*There are many wise and experienced midwives who choose not to license.  Some have called them “lay midwife.”  I do not because I think the whole term “lay midwife” is oxymoronic.  This bill isn’t addressing these unlicensed midwives anyhoo.  It is addressing SC licensed midwives.