Category Archives: Doula

Tension in the LDR

Posted on

I had an awful, no good, horrible experience with a nurse during a birth over the weekend.  I’ve never encountered anything like it.  Nurses are usually so wonderful.  I don’t know the back story.  Maybe this nurse had a bad experience with a doula. 

We had been laboring at the hospital through the night for 12 hours when shift change happened.  My client didn’t get a great vibe from new nurse (and really didn’t like her perfume) but we had no idea how bad the vibe would get.  New nurse came in after a few hours and said “you’re not in real labor, you know.  You know such and such (interventions) will be necessary.  It isn’t looking good.”  What?  Who tells a woman who has labored for 12 hours that she isn’t in labor?

Now part of my job as a doula is to maintain a protective bubble around the mom so she can do the work of birth.  I don’t normally speak on my client’s behalf or interrupt medical professionals.  But these words were, in my opinion, really harmful to the current scene.  Normally, nurses do not “diagnose” like this.  Especially when they’ve just arrived and haven’t even gotten to know their patient.

So I jumped in with “we really want to hear positive words right now.  [Client] has been doing so great!  And she had a wonderful labor pattern going when she was able to be out of the bed.  Maybe if we could sit by the bed again?”  (client’s doctor had asked her to remain in bed for a while). 

New nurse:  “How long have you been doing this?” 

Oh my.  Me (with a smile):   “I don’t think that is relevant.”

New nurse:  “No, how long have you been doing this?” 

Me:  “3 years.”

New nurse:  “Well, I’ve been doing this 15 years.  And what is your medical background?”

Me:  “I don’t have a medical background.  I’m not in a medical profession.  Look, I’m not challenging you.  I totally respect you.  We don’t need to bring this tension into the room.”  Keep in mind, we are having this conversation right in front of the laboring mom, her husband, and her mother! 

New nurse said a few words I don’t remember and left the room without speaking to the laboring mom.  Suddenly everyone is tense.  The mom is upset.  I’m apologizing to everyone for what just happened–utterly mortified. 

Soon after, new nurse came in and abruptly said to the mom, “You need to decide who will stay with you during delivery.  This room has one person too many.”  First, this is the same nurse who said the mom wasn’t in “real labor.”  Why is she worried about delivery, then?  Second, the mom chose this particular hospital because they permit 3 people in the room during delivery.  Immediately the mom is more upset because the nurse is contradicting the policy mom was told during the hospital tour and by her doctors.  New nurse is “really sorry she was told that.” 

At that point, the dad stepped in and became even more of a hero (he’d already shown his superhero skills overnight).  He went to the charge nurse and told her that their nurse had an odor that was making his wife sick.  They needed a new nurse.  And guess what?  Our new nurse was FABULOUS!

For the record, doulas are not medical caregivers.  But we do know a thing or two about childbirth (which many of us do not view as a medical event anyway).  We usually have a few tricks for labor progression or comfort.  And we are awfully concerned with the emotional climate surrounding our clients.  That is our job.  

My friend, Laura Clay, would have said, “New nurse, it is obvious you did not graduate from the College of Good Customer Service.”

Purple

Posted on

img_7974I’m feeling purple lately.  My purple day-lilies are blooming and grace the house with their showy petals. 

I’m wearing the purple bellychime Scott gave me.  I love the unobtrusive gentle chime it makes against my growing bump–ok, more than a bump.  Way more. 

And, one of my snazzy former clients gifted me with a violet doula shirt to get me through the summer.  My current one was looking a tad leotardish and would have surely ripped at the seams by June.  My new prana shirt is even made from post-consumer PET (that is plastic bottles–hoorah!). 

Speaking of doula gear.  I am particular about what I wear and carry to births.  My hubby–who is a complete outdoor gear freak–has taught me that gear can make or break an experience.  When I leave for a birth, I don’t know how long I’ll be gone, how long I’ll wear my clothes, what the temperature will be, if I’ll get wet, etc.  I wear prana clothes because they are durable, comfortable, flexible, and dry quickly.  Prana specializes in yoga and rock-climbing gear which seems perfect for the the contorted positions I end up in at births.  My socks are smartwools–again, they dry quickly.  My shoes are Mions.  Scott researched and selected the shoes–designed by one of the Keen founders.  I was skeptical (I thought they were ugly).  But, oh wow.  They are so comfortable and they have incredible techy features.  They repel water, the ergonomic footbed can be removed and washed, and they are mostly made from post-consumer materials in factories using wind and solar energy.  Oh, and they have wet/dry traction so I don’t bust it while I’m supporting a client.  Unfortunately, I don’t think the company is still alive; although the product is still be sold in limited supplies.  On a side note, weirdly, every female OB that I’ve worked with has asked about these shoes.  Every one.  Finally, my bag is the Osprey Elroy made almost entirely from recycled materials.  The fabric is 100% post-consumer PET (more plastic bottles).  Thanks Scott!

Enough digression about my doula-gear.  I’m feeling bluish-purple about my upcoming maternity leave from doula-ing.  I’m going to miss it.  And I hope I can find clients again after an absence.  Since I can’t exactly leave my laboring mamas to pump breastmilk, maternity leave will necessarily be long. 

I’m also completely booked for the remaining months before my birth.  I’ve had to turn a couple of families away which was tough for me to do.  But I know there are limits.       

My new big-belly accomodating doula shirt

My new big-belly accomodating doula shirt

Just another pregnancy update

Posted on

img_7711-21I’m 24 weeks or is it 25?  I don’t remember.  I usually cheat and hop over to Jenny’s blog to check–she’s due the same day as me. 

Pregnancy-wise, everything is normal.  Nothing much to report.  My belly seems huge and I feel like I’m carrying high.  No more sleeping on my tummy.  I wish I grew those cute basketball bellies. 

I crave belly-rubs and my friend, Carey, obliges weekly with a heavenly rose-lavender oil massage.  This child is almost always moving which has become irritating at night–it keeps me from sleep.  I was never irritated by Norah moving. 

My only food cravings lately have been swiss cheese and crushed ice.  I continue to drink oatstraw/nettle/red raspberry leaf tea daily.  I’ve added DHA/EPA to the prenatal routine.  Like a good girl, I take my cal/mag before bed and drink some chlorophyll in my oj each morning.  I won some prenatal chewable vitamins which I was super-stoked about.  Until I tasted them.   

Some of you have asked about my birth plans.  I’m not really keen on sharing much online at this point.  I promise to post all the details after Cedar is born.  I will say that I am excited about birthing again.  I’m trying out Hypnobabies since I’m currently training as an instructor.  My one worry is that Hypnobabies is notorious for short labors and I don’t want mine to be too quick!  But Cedar will come as Cedar is meant to come. 

Scott has beautifully kept the gender a secret.  I don’t have a clue or an intuition.

In terms of doula-ing, I have a busy, busy summer ahead!  I have such a diverse group of clients in the next couple of months.  And I’ve already had inquiries about hypnobabies classes this fall.

I had the worst heartburn of my life today while out shopping.  Thankfully, I had some papaya tablets in my doula bag.  I’ve never taken anything for heartburn and I’m happy to report that the papaya worked withing minutes!  I know it doesn’t work for everyone.  But I won’t be separated from it for the duration of this pregnancy!

Currently reading:  Obstetrics Illustrated, Natural Pregnancy Book, The Art of Hypnosis, Holistic Guide to Embracing Pregnancy and Birth, and Eve.                  

Oh, and a fun little book I found at the flea market this week:

img_78081

Seeking a March Birth

Posted on

I try not to schedule more than two births a month.  I’ve learned that is my limit in giving my full attention to clients.  However, both of my March births delivered in February!  (Congratulations ladies–two quick unmedicated births!) 

So, I find myself with an empty month.  On the one hand, this free month feels like a nice time for spring cleaning and baby preparation.  On the other hand, a whole month without a birth!?

So, if you know of anyone due in March, I would be oh-so-happy to serve them as a doula or offer a private childbirth class…

Work Blunders: A Year in Review

The top 3 most ridiculous things I’ve done or said as a doula in the last year.  WARNING:  may not be for the weak-stomached and if you’re a current client, you might lose complete confidence in me.

1)  I chased a placenta down a hospital hallway.  It was almost midnight and I hadn’t had anything to drink or eat since noon.  The client asked me to take her placenta home so she could get it later.  Staggering under the glaring lights, I walked into the hall holding my birth ball, doula bag, and odd tupperware-like container of placenta.  I dropped the container which then rolled an enormous distance past the nurse’s station.  I dropped my bag and ball and bounded like a toddler after the container much to the amusement of one OB and several nurses.  Thankfully the container remained closed.  Could have been a disaster.

2)  I made up a story about marshmallows.  I had a client who seemed to respond well to mental imagery during contractions.  I was doing ok at first with the usual “Imagine you’re in the center of a field on a breezy day…”  Then, after so many of those, I went blank.  She was lying on white sheets with fluffy white pillows so I said something so embarrassing like “You’re climbing a mountain and when you get to the top, you realize you’re on the edge of a bowl of marshmallows.  And you spread your arms and fall into them.  Smell the powdery sugar.”  And if the image wasn’t bad enough, the client followed a kosher diet and I couldn’t remember if marshmallows were kosher!  It was awful. 

3)  I wiped meconium poop with one hand while eating chick-fil-a with the other.  I was starving.  And the glorious saint of a dad called his mother to bring me a chick-fil-a sandwich.  It didn’t arrive until the mom was pushing so it got dropped in the shuffle.  During the birth, my entire chest got covered with amniotic fluid.  As soon as baby was breastfeeding, I grabbed my sandwich and started munching.  Then baby pooped on mom’s hand.  So, wearing a saturated shirt and with my half-eaten sandwich in one hand, I used my other hand to clean her up with wet wipes.  A few years ago, that scene would have really bothered me.

It was a good year.

So you want to be a doula

I frequently encounter women who say “I think I’d like to be a doula.”  I get that.  For those of us who love birth, what better profession to choose than midwife, l&d nurse, doula? 

It does sound like fun–emotionally and physically supporting couples during one of the most important moments of their lives; being invited to witness such a stunning event.  And it is.  I love being a doula.  It is the best job I’ve ever had.  But…let me also share the reality of the profession.  Just like any job, it has challenges.  And I don’t think I really thought about these challenges before jumping headlong.

Looking over my births this year, the average amount of time I spent with a client in labor was 12 hours.  So while that means I may have had one four hour labor, I also had a couple of 20+ hour labors.  And I have no way to predict how long I will be gone when I kiss my toddler good-bye.  And I bail on my friends all the time.  Choosing this profession means that I commit to my clients that I will be with them through their labor.  I look at it this way:  What would it feel like to a mom who has been laboring 15 hours for her doula to leave?  To call in a replacement?   

I’m on call.  Enough said.  Ask my husband how he feels about that one.

I have a list a mile long of friends and family who can care for Norah.  I regularly interrupt their lives with sentences like this “Hi friend.  So I have this client who might be in labor.  If she calls me before 6am, Scott will take Norah to person A.  But if she calls after 6am, can I bring her to you?  Oh, and I don’t know who will pick her up or when.” 

My job is to support women who are feeling discomfort.  For hours.  At 4am, when I’ve been there for 10 hours already, I do sometimes question why I’m doing this. 

Doulas must be physically lithe.  Seriously.  I contort into bizarre positions to apply counter pressure to a woman laboring in a tub.  I crawl around on the floor, hold women carrying an extra 30lbs in a supported squat, climb on top of hospital beds, and let my hand be squeezed…really hard!  

alicia-009
Somewhere around hour 13. I kept sliding backward as I applied counterpressure.

We need to have strong stomachs and gracious hearts.  I’ve been kicked in the face, covered with amniotic fluid, and I’ve cleaned up lots of poop and vomit.  While I’ve not yet been cursed at, I have had a birth ball thrown in my general direction.

Sometimes (though not too often), the rest of the birth team doesn’t want you there.  Sometimes nurses don’t like you.  Or sometimes, the client’s family resents that you get to be at the birth instead of them.

Doulas must hang in there emotionally.  It is hard to not get distracted by discouragement, hunger, the need to pee, conversations between nurses or midwives, a husband asking when are you coming home, or just fatigue.  Our intuition is key and for that we must stay alert and in the moment.

Finally, after the joy of birth (which of course makes all the work worth it!), it is hard to leave.  After the postpartum care is over, it is difficult to suddenly not see this family you’ve worked so closely with over the last weeks or months.

I’ve worked in non-profit, corporate, education, and ministry.  Doula work is by far the most difficult.  And the most rewarding.  I take my definition of doula as Jesus and early Christians used the word:  slave.  The One I most want to emulate was described as emptying himself and taking on the form of a doulos–the male form of doula (Philippians 2:7).  What better role model?

Pregnancy, Power, and Parenting

I spoke yesterday at an Attachment Parenting Forum.  The topic was how choices in childbirth were related to the first AP Principle:  preparing for pregnancy, birth, and parenting.  I joined a forum with a midwife and two childbirth educators

In my classic style, I did not prepare at all.  I had no idea what I was going to say.  So I was pleasantly surprised when coherent words came out of my mouth.  And I was even happier that when I finished speaking, I agreed with what I had said.  Sounds schizophrenic, yes?  Welcome to my public speaking technique.    

I said that one of my primary roles as a doula is to guard power.  I don’t care what kind of birth my clients choose or end up having; my concern is that they retain their power throughout.  They are not bullied or undermined.  They have informed consent.  They understand and claim responsibility for their birth.  The power of pregnancy and birth springboard us into confident parenting.  When our friends and family question our AP methods or on a sleepless night 5 months postpartum, we question ourselves, we can draw on the strength and trust learned through birth. 

Parenting is not rocket science.  It is much harder.  It calls for something more than mere instruction manuals.  It demands an inner strength beyond anything else.  Those 9 months of pregnancy and however many hours of labor and birth can lay a firm foundation for our parenting; particularly when our choices are questioned at every turn.

A doula’s challenge

Each week, I send an email to my pregnant clients.  These emails are usually for their eyes only but I thought I would share a recent one.  Note:  most of my clients (lately) are hospital births so we typically spend much of the labor in their homes.   

Restraint.  When folks ask me what is the hardest part of being a doula, I answer “restraint.”  We doulas get riled up about doctors and midwives who use unnecessary interventions.  “Humph,” we complain.  Why can’t they simply trust birth? 
 
But we are often guilty of the same thing.  When I first began as a doula, I thought I was supposed to whip out all my tricks and tools.  I figured these families were paying me to do something.  My thoughts went something like this:  “Ok, I need to do x to keep her labor from stalling.  I should do y to make sure the baby descends.  I must do z to encourage her to release more oxytocin.”  You realize what I was doing?  Using unnecessary interventions.  Maybe they were harmless and maybe they even helped but they may not have been necessary.  And sometimes, they took away power from the birthing woman. 
 
Why couldn’t I simply trust birth? 
 
Do you remember those early studies on doulas–you know, the ones that showed incredible reductions in c-sections and other interventions and incredible increases in mother satisfaction?  Most often, the mom didn’t even know she had a doula.  The doula was simply present as part of the medical team–it was a blind study.  Her mere continued presence resulted in positive outcomes.  How could that be? 
 
It is a tricky profession.  In the aftermath of a normal birth, it should feel like the doula or the midwife/doctor didn’t do anything.  Our goal should be to fade into the background of the story.   
 
Now don’t worry–this rambling doesn’t mean that I’m not going to give you nice foot massages or help you relax during your labor.  It does not mean that if I suspect any roadblocks (positioning, difficulty focusing, etc), I won’t pull out a trick or two.  But if your labor is progressing normally, sometimes the best tool I have is simply to be there.  To be a gatekeeper or lifeguard; not a director.  And yes, I struggle with this.  I want to jump in and save the day. 
 
Ah, but you don’t need to be saved.  This journey is yours and you are the hero in this adventure. 
 
Homework:  Trust is an essential element in normal birth.  Do you trust your body?  For some women, pregnancy may offer the first challenge of this sort; the first opportunity you’ve had to be awe-struck by your amazing body at work.  Practice trust and intuition by asking and listening during pregnancy.  For example, thoughtfully ask yourself questions like “how does my body want to stretch?” “should I rest now?” “what would nourish me today?”  
 
This quote was written to midwives but I think it applies to all those who are invited into the presence of birth: 
Do good without show or fuss. 
Facilitate what is happening rather than what you think ought to be happening. 
If you must lead, lead so the woman is helped yet still free and in charge.  
When the baby is born, the woman will rightly say, “We did it ourselves.” 
–from the Tao Te Ching

“Soon They’ll Be Asking for Informed Consent”

I caught that line from an overheard snippet of House M.D. recently.  Someone told House to get consent before a procedure.  He sarcastically replied something to the effect:  Start getting consent for procedures and soon they’ll be asking for informed consent.

Well there is a new tool in the informed consent workshop.  Released this week, the Milbank Report:  Evidence-Based Maternity Care Report has the US abuzz.  Consumer Reports even released a report on the findings.  One of the quotes I love in the Milbank report’s executive survey is “The many beneficial, underused practices around the time of birth include continuous labor support, numerous measures that increase comfort and facilitate labor progress, nonsupine positions for giving birth, delayed cord clamping, and early mother-baby skin-to-skin contact.”  Humph.  Nonsupine positions, delayed cord clamping, and immediate skin-to-skin are usually the most difficult concessions to get in hospital births I attend.  There is always some reason why it can’t be done. 

The sum-up of the findings seems to be hire a family practice physician or midwife to attend your birth, hire a doula, and know which processes are evidence-based.  Not sure how to discern evidence-based practices?  I usually go first to the Cochrane Database of Systematic Reviews.

The Gamut

Two back-to-back births that ran the gamut.  One striking difference was the OB management of delivery. 

Dr. Masked Man:  He showed up only when baby was crowning.  He involved a surgical tech who draped the mom’s legs and torso in blue sterile paper.  To hold her legs, I had to fight with the ridiculous paper and I did get “the look” from the tech when I rubbed the mom’s thigh over the paper.  The dr. wore a surgical mask, a face shield, a scrub cap, long gloves, full scrubs, and boots.  It could have been anybody under that getup!  The surg tech kept pouring soapy water on the mom without warning and scrubbed her down with antiseptic.  The room was bright and filled with people.  When baby was born, dr. immediately clamped the cord.  Baby was held up (for the photo shot maybe?) and then handed to a nurse for twelve million footprints and procedures.  Then dr. applied strong cord traction for the placenta. 

Dr. Polo Shirt:  Wore casual “street clothes.”  Called the mom by name.  In fact, he called all of us by name.  The room was dim and the only other person was the nurse.  When baby was born, dr. handed her to the mom.  He patiently waited for the cord to stop pulsing while the mom breastfed.  Cord clamped (and cut by me–my first!), mom cleaned up, and dr. patiently waited for the placenta.  He quietly respected the postpartum time by slipping out of the room.  He came back later to quietly bid us all goodnight.   

Which would you choose?  And how would a newly pregnant mom know to even ask the questions to find the right choice?