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Favorite Part

An hour or so after one of my clients gave birth, she looked at me and asked, “What is your favorite part about being a doula?”

Before I answer, I will tell you what is not my favorite part.

Some people think I’m a doula because I adore babies and want to squish their widdle cheeks.  And they imagine I get to hold them all the time.  As if I chose my profession to get a newborn fix. 

If you knew me before I was a doula, you would laugh.  I was the person at the office party that stoutly refused to hold the baby du jour.  Even as a high-demand teen babysitter, I took my little sister along to change the diapers.  When I found myself pregnant, I was horrified by how little I knew about babies and how to handle them. 

No, I did not become a doula because of babies. 

Now don’t get me wrong.  I love babies (now).  I can swaddle them like a Moe’s burrito or wrap them to their mama using 15 feet of fabric in 30 seconds flat.  I know the 5 s’s.  I have a three-point lesson on just about any baby subject.  Ask Emily who called today because her 10 month old is biting while nursing.   

But these babies aren’t mine.  You won’t see many pictures of me holding my client’s babies.  I won’t refuse but I will not ask.  I don’t view newborns as individuals yet.  They are a couple–mama and baby.  Attached as firmly as if the umbilical cord was still intact.  If I do find myself holding a baby on the day of his birth, I’m extremely anxious to reunite baby with mama.    

As I looked as this woman with her dreamy post-birth smile, I could answer without hesitation:

My favorite part about being a doula is seeing a woman in her strength and power give birth.  In this single act, she shows courage, joy, sacrifice, faith, resolve, exhilaration, vulnerability, generosity, and above all, love.  It is such an honor to be invited to witness and support women on such a journey.  That, my friends, is a fix.

I had to laugh when I looked at this picture from my last birth.  I was leaving and someone asked to take my picture.  What am I holding?  A baby?  Nope.  

A placenta.

  Yep, I’m much more likely to be holding a placenta than a baby.  Up next, placenta prints!

First Time Mom (Homebirth Story)

New birth story up!

Students becoming educators

Lately my childbirth students have been teaching medical professionals all about birthing positions.

1)  A first time mama was her OB’s first natural birth.  Seriously, first natural birth EVER witnessed.  And my student gave birth standing up!  Providing her own counter-pressure while her husband sat on the bed and held her from behind.  She gave birth to an 8lb+ baby without any tearing.  She said she felt her OB and nurse believed her to be a giant liability disaster waiting to happen! 

The next day, her OB had lots of questions about the birth.  The OB was surprised the woman did not “blow out her vagina.”  OB:  I’ve always supported the use of epidurals so I can control pushing and you don’t blow out your vagina.  But you didn’t seem to have a problem.  Mom:  I had instant feedback from my body about how fast/slow to push.  

2)  This mom was a VBAC who never got to active labor during her induction with her first baby.  And she wasn’t “allowed” to get out of bed.  This time, she stayed at home and birthed 17 minutes after arriving at the hospital.  She chose a hands/knees position.  There was no doctor on the floor so three nurses assisted.  The one catching had never done a hands/knees births.  I could pick up on some anxiety about the position but mom did all the work.  She made it easy for the nurses.  And thankfully, they were supportive of her choice–not that I think she would have willingly changed positions at that point!  The nurse passed the baby straight to mama where she snuggled skin-to-skin for over an hour. 

3)  A resident had only done back births.  Her words:  “I see that you’re pushing well on your knees.  But what I like to do for natural births is break down the bottom of the bed, scootch you down and have you pull your legs back.”  I wanted to ask, “Um, how is that different from medicated births?”  Mom was tricked onto her back “so we can check you.”  But she rolled to her side.  And instinctively gave herself her own counter-pressure.  This clearly made the resident uncomfortable but the mom ignored the nurse’s attempts to move her hand.  I heard the attending whisper to the resident “the manuevers are the same for a side birth as a back birth.”  When the resident gave me some instruction I can’t remember now, I replied, “Oh, ok.  I haven’t done a back birth in a long time.  The last birth I attended the mom was standing up.”  Wide-eyed resident shook her head in disapproval.  Sigh.  I hope that one moves on to a hospital far far away. 

I’m so proud of my students and other families who are changing the way birth is “managed” in the hospital.  It can be a tricky place to navigate and the balance of power can be overwhelming.  I think of my client who had a breech baby.  While she knew cesarean was her only option in the hospital, she also insisted on delayed cord clamping and skin-to-skin contact.  She made a path that other women can more easily trek. 

These amazing families inform and change one birth at a time.

Preparing for a Smooth Hospital Birth

Each hospital birth I attend is a learning experience.  Here are some common characteristics of the most positive hospital births I’ve attended:

Before Your Birthing Time:

Early communication with care provider:  There shouldn’t be any surprises between the couple and the care provider.  Communicate your desires and expectations early in your pregnancy.  I understand that more and more OB groups are now including multiple care providers and each OB may support different practices.  This challenge is even more reason for you to communicate clearly and ask the question, “Will the other OBs in the group also support ______?”   

Hire an independent doula:  You knew that was coming, right?  An independent doula (one who does not work for the hospital) knows the way hospitals work.  I cannot imagine laboring without the continuous support of a woman who is there only for my physical and emotional support.  Especially for a hospital birth.  Please don’t let financial concerns stop you from interviewing a few doulas.  Find a student doula, barter services, or use your flexible spending account.

Take an independent childbirth class:  By independent I mean a childbirth class that is not offered by the hospital.  I don’t think it really matters which class you take.  Pick one and stick with it.  Childbirth classes are as important for the birth partner as for the mom. 

Pack only one bag:  For the initial admission into the hospital, try to condense everything into one bag.  Triage rooms are tiny.  Leave all the postpartum supplies in the car.  Bring only what is needed for the labor and birth.  You don’t want your nurse rolling her eyes at the first-time couple bringing 5 bags into the room. 

During Your Birthing Time:

Stay home:  The couples I work with who report the most satisfaction in their births are the ones spend most of their labor at home.  Even more reason to hire a doula–she can help you feel comfortable about deciding when to go to the hospital.  At home you have privacy, hydrotherapy, familiarity, nourishment, and power.  My recommendation is once you feel it is time to go to the hospital (unless you are arriving very late in the game), take a moment to take a shower/bath or freshen up.  Use this time to gather your focus and repeat your affirmations.  This can also remove you from your birth partner’s fluster of loading the car!

Stay hydrated and nourished:  Your birth partner and doula should be on top of this task.  I’ve noticed that most of the time, if a confident mom is drinking or eating at the hospital, the nurse usually turns her head.  I remember during one birth, I simply blocked the nurse’s view and told her the mom was drinking some water.  The nurse replied, “Yeah, I can’t see that or I’ll lose my job.”  And that was that.  In this case, it is easier to ask forgiveness than permission. 

Stay cooperative and positive during admission:  The admission process is ridiculous.  The number of consent forms keeps growing.  When you have a pressure wave, simply stop signing forms and focus your attention.  Hold your hand up or make a “shhhh” sign if a nurse continues to talk.  You do not have to be hurried.  Some hospitals allow you to come in before your birthing time to sign forms.  Ask if this is possible. 

Be confident and make the first move:  It is important to present a confident demeanor.  This task can fall on the birth partner if it suits his personality.  The birth partner should make the first move when the nurse arrives (once you’re in a room and know who your nurse will be).  He should introduce the birth team–calling mom and baby by name; introducing the doula.  I call this move “disarm by charm.”  The birth partner should also use every opportunity to brag on the mom.  “Isn’t she amazing?” 

Bring goodies:  Nothing like a little surprise to woo your birth team.  Bring at least three gifts for nurses (there could be shift changes or a student nurse).  One nurse told me she loved 5.00 starbucks gift cards since there was a starbucks in the hospital lobby.  This is not bribery.  Oh no, no, no. 

Do not stay in bed:  A great nurse will examine you or perform procedures in alternate positions.  However, if your nurse is not comfortable with this, use the bed for the duration of an exam/procedure only.  If you are being monitored, sit or stand by the bed, use the birth ball, or request a telemetry unit (if available).  Your partner or doula can volunteer to hold the monitor in place for wiggly babies.  In my experience, once you are in the bed, the monitors and blood pressure cuff stay on.  If you would like to lie down, consider using the couch!   

Stay unhooked:  Each time you are hooked up to a monitor, ask the nurse for a time frame.  She will likely leave.  If she has not returned by the time she gave you, unhook yourself. 

Control the mood:  Keep the lights low.  Keep the door closed.  Have music playing.  Massage mom with some lavender oil.  Use a low tone of voice.  If you create an atmosphere of serenity, your nurses and care providers will usually join in.  At a recent birth, the nurse commented on how much she loved coming into our room because it was so peaceful.  She automatically relaxed and lowered her voice.  If your nurse forgets to turn the lights down or shut the door when she leaves, the birth partner or doula should jump on it. 

No one should talk during pressure waves:  Maybe the hospital staff will join in the silent tribute if the birth partner and doula are quiet during mom’s pressure waves.  I’ve noticed that hospital staff can be quite chatty during labors.  Staying quiet during waves reminds everyone to keep their focus on the mom.  The birth partner may “shhh” someone if needed.

Memorize BRAIN:  What are the Benefits?  What are the Risks?  What are the Alternatives?  What does my Intuition tell me?  And what if we do Nothing?

Order a squat bar:  If your hospital has one (or more), request it.  Sometimes it takes a while to find it (and dust it off). 

Have a SHORT birth plan and/or baby care plan:  I think a birth plan can be a positive tool.  Include the names of everyone on the birth team and include the baby’s name.  Keep it short.  Do not include things that are easy to speak up for in the moment–like freedom of movement or minimal vaginal exams.  I recommend focusing on 2nd stage and 3rd stage birthing practices–birth position, routine 3rd stage pitocin, cord care, pushing, immediate skin-to-skin, etc.  These are the times that mom needs lots of support and focus.  Your nurse can help facilitate your birth plan at this point.  What is a baby care plan?  I’ve noticed that it is tough to communicate with the baby nurse in advance.  She often arrives as “delivery is imminent.”  She doesn’t know you.  Doesn’t know what you want.  You can create a simple baby plan and place it in the newborn warmer for her to find as she sets up.  Include the things that are important to you:  immediate skin-to-skin, procedures that should be delayed at least an hour, procedures you are declining, etc. 

When you feel “pushy,” wait:  This one might be controversial.  Things seem to get a little wild in the hospital when it is “time to push.”  If you’re laboring quietly and you feel some spontaneous pushing sensations, try to ignore them or bear down a little.  It is a great time to hang out in a dark bathroom with the door closed.  There is no need to rush the drama that will come.  Sometimes you begin feeling “pushy” before you are fully dilated and you’ll end up with several vaginal exams, instructions not to push, words tossed around like “anterior lip,” and “you’ll tear your cervix.”  You really don’t need multiple fingers messing with your sphincter when you’re trying to release a baby.  If you’re comfortable, lie low and wait until you have the absolutely-can’t-help-myself-hurling-pushing waves to call in the staff. 

Don’t give up the baby:  Finally, your little one is in your arms.  Barring medical concerns, keep the sweetling in arms.  If the well-meaning baby nurse says “let me just take him for…” understand that it could be 15-30 minutes before you get the babe back.  Delay, delay, delay.  Eye ointment, shots, footprints, tagging–these things can be delayed and they can also be done in mama’s arms.  Keep your newborn skin-to-skin as long as possible.  Just say “no” with a disarming smile, of course.

A new mom

Just in time for Mother’s Day, a new mom met her baby!  Here are the highlights:

  • She spent most of her labor at home listening to good music, changing positions often, walking outside, using water therapy, and resting.
  • Her doctor made a surprise house-call to check-in and reassure. 
  • Her husband caught the baby over an intact perineum–hoorah! 
  • Baby had uninterrupted skin-to-skin contact with his mama.  When I left, he was still warm and snuggled–having never left mom’s chest.

Happy Mother’s Day to a precious new family!

Brady’s Birth Story

[shared with permission]

I had not thought a lot about birth before I became pregnant with Preston. All I did think about birth was mainly negative and never in my wildest dreams would I have thought it could be such a positive experience. I think if more women shared their positive birth stories, we would have a different view of the whole birthing process. Before I start I do believe that every woman is entitled to bring her child into this world how she wants to.  So here is how Preston entered this world, hope you enjoy it and take something from it.

Tyler and I decided that we really wanted to bring Preston into this world without medication or interventions during labor. We started working with our doula, Julie, who educated us on how to follow through with the birth we wanted. Tyler and I read and read and researched and took classes and met with Julie and asked probably a million questions. We learned how to labor together and different methods to help ease the pain of labor. Finally the day was here!

January 24th, 2009
I woke up with a lot of back pain and just did not feel good. Tyler and I went for a long walk and still the pain did not ease up. Needless to say I spent a lot of time in the bath and having Tyler apply counter pressure to my back. We watched a movie and I tried to sleep but could not.

January 25th, 2009
We called Julie around 6:30 a.m. and she told us to try and get some rest. I got into bed and ended up sleeping for about 3 hours. Thank goodness I got at least that because little did I know I was about to do the hardest thing I have ever done in my life. Julie decided to come by and check Preston’s position (most posterior babies put a lot of pressure on the back during labor causing the mother to have back labor). Julie walked in at 11:54 and my water broke at 11:57. I remember being excited and scared all at once. We were going to have a baby and I was going to meet Preston, but at the same time I knew that I had a big job cut out for me. My labor progressed quickly. Julie wanted to try to see if Preston would rotate, so that he would be anterior and take some pressure off my back. After doing what she called the “rotisserie,” Preston flipped.

img_7407Labor was starting to get very challenging and I just kept pacing and had not gotten my rhythm down to get through my contractions. My personality is so independent and I think I can do everything myself but I realized that I needed Tyler and I needed to allow him to help me through these contractions. I finally got into a ritual during my contractions. I leaned on Tyler and held his hands over my face and rocked back and forth. Strange, but it seemed to work. My contractions were getting so intense; we decided to head to the hospital. I have to admit in the back of my head I was thinking that natural childbirth was for the birds and I was wondering what I was thinking doing it naturally! The car ride was interesting, my contractions seemed to be back to back and Tyler was driving like a race car driver to get me there. I think he was a little nervous about birthing a baby in the car. I remember not wanting to hear any noises, it was like I was so deep into myself that everything around me was a big blur.

We arrived at the hospital at 3:30 p.m. and instantly I wanted to push. It was a feeling that was welcomed and one you cannot resist. It is funny how your body just takes over and knows exactly what to do (if you allow it to). We walked in and got into the room and immediately I was pushing. The nurse tried to get my IV in, but she failed because my contractions were coming and I could not help but move. I was exhausted and I really wanted to just rest. I kept thinking if I could just rest then maybe I could do this, but I had to dig deep way down inside me and find the strength to continue pushing. Julie and Tyler were great and really helped me to find the strength I needed to get Preston here. I remember thinking that this was much harder than I ever thought it was going to be, but then I felt Preston start to crown and I knew that Tyler and I would be able to meet our son soon if I could just keep pushing. At 5:27 pm Preston was in my arms and it was the best feeling in the whole entire world. Tyler and I created this img_7465beautiful child and all that work during labor was what got him here.

Labor is not easy and it was the hardest task that I have ever done; however it was the most rewarding. After Preston’s birth I felt stronger than I have ever felt in my life. There were many times during my labor where I hit walls and I wanted to quit, but I did not. I climbed them and that feeling is a remarkable feeling. Tyler and I are closer today than we have ever been. Going through the labor experience together fused us together even more than we were before. It took “us” to a new level. Looking back at Preston’s birth it was one of those memories that I will treasure forever. Did it hurt? Yes. Was it hard? Yes. But I learned more about myself and what I am capable of in those 6 hours than I could ever imagine. So childbirth can be a positive experience and I cannot wait until I get to do it again! It is a beautiful part of life and I am blessed to have experienced it.

[I would like to add that Brady made many healthy choices in her pregnancy.  She also made the difficult choice of switching care providers and hospitals in her last few weeks to a more natural birth-friendly practioner.  When I saw Brady and Tyler at a postpartum home visit, they were beaming with respect for each other and adoration for their baby.  It is such a pleasure to watch them grow into a family!] 

Extraordinary Ordinary Birth

I was up all night so forgive the choppiness.  I share this with permission from a new mama and daddy. They wanted to encourage someone else as other stories encouraged them.

I am honored to be the doula for an amazing couple.  This pregnancy is their first.  While taking a childbirth class (before even finishing the class), they met another expectant couple who didn’t speak English.  My couple invited them into their home, taught them what they had learned, and the non-English speaking couple had a lovely natural birth.  My couple did this before having experienced childbirth!  So, I knew it would be an extraordinary birth. 

Well, they experienced birth last night and this morning.  I labored with them through the night in their home–quiet, peaceful, beautiful.  They were so affectionate with each other.  I sometimes felt like I was eavesdropping.  She was quiet through her labor and the emotional cues were simply not there–she remained calm and relaxed the entire time.  Her pattern never changed:  contractions on the dot every two minutes.  Several times I asked if she wanted to go to the hospital (her planned place of birth) and she wanted to wait…and wait…and wait.  Finally, I encouraged her we needed to go.  It took some coaxing.  She was completely dilated when we reached the hospital! 

And a very short while later, a new little boy was welcomed to the world.