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Waves

Surfing the waves of contractions, photo by Folkert Gorter

Active labor.  Contractions are hard and occasionally whipping up higher than expected. Massage and hip squeezing isn’t working. The birthing mother’s voice is getting higher and tighter.

As a doula, sometimes in these situations I reach for a visualization. And for active labor, there is no better metaphor than waves. There are so many ways to use this metaphor. Here’s an outline you can use and embellish as you like on the spot.

Here comes the wave… Take a deep breath… Now dive under this wave and through it and through it…. and now you’re coming out on the other side… swim up… Take a breath… Let it go

It’s OK if there are moments of silence in between your words or sentences. You don’t have to be talking the whole time. Speak slowly and use a low, calming voice. If she follows your lead, her own imagination will be filling in most of the details. You are just there to give her a bit of guidance. By focusing on this image of a wave, she can more easily let go of other thoughts that might have been causing anxiety (like, “How much longer will this go on?” and “I’m afraid of the next one.”) Our minds will fill with thoughts if we don’t give them something to focus on.

If you’ve never talked someone through a visualization, it can feel strange to do it the first time. I think we fear that everyone will look at us strangely and wonder why we have started talking in a sing-song voice about waves. In reality, my experience is that everyone in the room is usually happy that there is something besides pain and, often, the blips of machines on which to focus. Often the birth partner and nurses in the room will quietly take part in visualizations and, if it appears to calm down or help the birthing woman, they will even take it up, adding their own voices to the visualization. You may feel funny at first, but if you give it a real try, I guarantee you will be pulling this trick out in a lot of births.

What’s your favorite visualization?

 

What do doulas need in their stockings or in their Hanukah packages? Hmmm, I thought I would dream about good gifts for doulas. I am VERY practical gift-giver. I like gifts to be useful and not anything that will add to clutter. I suppose some will think “thank you notes” could add to clutter, but I think they also add to a nicer world, so they remain on the list. Cheers!

I am reposting this list from a few years ago, but it’s all still true!

1. A  rolling pin from Palumba (http://www.palumba.com/full-size-wooden-pastry-rolling-pin.html)

I always carry one in my doula bag in case a laboring mom wants back pressure during contractions. After about an hour, I can’t do hip squeezes anymore. My wrists give out. But I can run a rolling pin over a mom’s lower back for 20 hours. I know. I’ve done it! If I use the rolling pin during labor (probably about 1/4 of the time I do), I give it to the parents as a baby gift along with a cookie recipe at my first prenatal visit. It usually gets a smile.

2. Beautiful Thank you notes, maybe with her name embossed on them?

Always a good idea to have a package of thank you notes in your doula bag for nurses, doctors, midwives, lactation consultants. For anyone who is helpful in any way at the birth. Helps spread the love for doulas a little bit further.

3. Essential oils

I get my essential oils at a great local shop called Indigo Forest. Beth will ship to you and consult by phone about your essential oil needs. She convinced me this year to carry frankincense with me and I am glad she did. It’s such a useful essential oil! You can google its many uses (or call Beth and ask her. She’ll convince you, too!) Of course, the moms you attend may or may not be into essential oils, but even if the mom I am attending does not want to use them, I use them on myself! I always, always have lavender for calming myself down. It works in an instant. It’s like deep breath in a bottle. If the mom I am working with does not like scents or finds aromatherapy too “out there”, I am careful, of course. I just smell my bottle, I don’t put any on my skin. And if she is allergic, then, sadly, I don’t use them at all. (Indigo Forest is http://visitindigo.com and phone (734) 807-9909)

4. Honey Sticks

I get these at our local farmer’s market. If someone bought me a package for Christmas, I would be thrilled. I always have to make sure my kids (aged 10 and 7) haven’t gotten into my stash before I attend a birth. They are so great for an energy burst (for mom-to-be or me or, in one case, the tired doctor).

5. A donation to a birth-related cause on kickstarter or another crowd-funding website

There are a FEW birth-related projects out there looking for funding. 

What do doulas need in their stockings or in their Hanukah packages? Hmmm, I thought I would dream about good gifts for doulas. I am VERY practical gift-giver. I like gifts to be useful and not anything that will add to clutter. I suppose some will think “thank you notes” could add to clutter, but I think they also add to a nicer world, so they remain on the list. Cheers!

1. A child-size rolling pin from Palumba (http://www.palumba.com/product/298/)

I always carry one in my doula bag in case a laboring mom wants back pressure during contractions. After about an hour, I can’t do hip squeezes anymore. My wrists give out. But I can run a rolling pin over a mom’s lower back for 20 hours. I know. I’ve done it! If I use the rolling pin during labor (probably about 1/4 of the time I do), I give it to the parents as a baby gift along with a cookie recipe at my first prenatal visit. It usually gets a smile.

2. Beautiful Thank you notes, maybe with her name embossed on them?

Always a good idea to have a package of thank you notes in your doula bag for nurses, doctors, midwives, lactation consultants. For anyone who is helpful in any way at the birth. Helps spread the love for doulas a little bit further.

3. Essential oils

I get my essential oils at a great local shop called Indigo Forest. Beth will ship to you and consult by phone about your essential oil needs. She convinced me this year to carry frankincense with me and I am glad she did. It’s such a useful essential oil! You can google its many uses (or call Beth and ask her. She’ll convince you, too!) Of course, the moms you attend may or may not be into essential oils, but even if the mom I am attending does not want to use them, I use them on myself! I always, always have lavender for calming myself down. It works in an instant. It’s like deep breath in a bottle. If the mom I am working with does not like scents or finds aromatherapy too “out there”, I am careful, of course. I just smell my bottle, I don’t put any on my skin. And if she is allergic, then, sadly, I don’t use them at all. (Indigo Forest is http://visitindigo.com and phone (734) 807-9909)

4. Honey Sticks

I get these at our local farmer’s market. If someone bought me a package for Christmas, I would be thrilled. I always have to make sure my kids (aged 10 and 7) haven’t gotten into my stash before I attend a birth. They are so great for an energy burst (for mom-to-be or me or, in one case, the tired doctor).

5. A donation to a birth-related cause on rockethub or another crowd-funding website

There are a FEW birth-related projects out there looking for funding. Here’s one that looks awesome to me: http://www.kickstarter.com/projects/1180845187/the-4th-trimester-bodies-project?ref=live

6. An extra few hours of sleep

If anyone knows where I can find this this December, please let me know. We are fresh out of this hot commodity in Ann Arbor. I’m hoping a new shipment comes in soon!

6. An extra few hours of sleep

If anyone knows where I can find this this December, please let me know. We are fresh out of this hot commodity in Ann Arbor. I’m hoping a new shipment comes in soon!

Russia Breastfeeding article

This looks like strikethrough text, but click on it! It is the link to my article about breastfeeding and “low milk supply” in Russia. We are so used to our own cultural context that we can forget that we ALL see pregnancy, birth, breastfeeding, and parenting through our own particular culture. As a breastfeeding conference is underway in my favorite city (Toronto!), I thought I would share this article I wrote a while ago about my experiences in Russia.

Things have changed in Russia since I did fieldwork there in 2000-2001, but I still think it is valuable to understand how others in the world think (or thought) about women’s reproductive bodies.
You can also get to this article by clicking on the words ‘Related articles” below. That brings up the Google link!
by C Gabriel – ‎2003 – ‎Cited by 2 – ‎Related articles

THE EFFECTS OF PERCEIVING “WEAK HEALTH” IN RUSSIA: THE CASE OF.BREASTFEEDINGCynthia Gabriel. The state of Russian health has declined.

A group called The Unnecesarean pointed out today that anesthesiologists, themselves, are aware that WALKING in labor (“ambulating” in medical terms) reduces cesarean rates. Though I am an advocate of natural hospital birth, I share the goal of reducing unnecessary cesareans. It seems to me that if “walking epidurals” are known to reduce the risk of cesarean in women who want epidural anesthesia, we should be offering these more often. (Please know that I say that with the belief that no woman should be offered anesthesia in labor that she does not want. Women who want a natural birth deserve FULL support for this!) As “The Unnecessarean” points out, the anesthesiologist quoted in this article is blunt in admitting that it is “easier” to manage laboring women in bed. But labor is not about ease. It is about birthing the next generation. It is worth the hard work of women AND hospital staff!

Here are some excerpts and a link to the article. Thank you to The Unnecesarean for pointing this out.

Most notably, only four of the patients who received a walking epidural experienced hypotension compared with 44 patients in the nonambulatory group. Only 113 in the walking group required bladder catheterization compared with 187 in the nonambulatory group. Motor block was seen far less frequently in the ambulatory group (14 vs. 145 patients in the nonambulatory group), and cesarean delivery was less common as well (53 vs. 65, respectively).

On the other hand, patients who received walking epidurals reported more pruritus and required more interventions, as demonstrated by higher total PCA volume and use of rescue doses of ropivacaine. The duration of labor was unaffected.

“Even with the benefits to the patient, walking epidurals are not used very often because they are more time-consuming in terms of patient management,” said study leader Shaul Cohen, MD, professor of anesthesiology at UMDNJ, in New Brunswick. “It’s much easier to keep them in bed with a Foley catheter. And it’s an insurance issue. Insurance companies pay for care not quality of care, and they won’t pay for the additional time and staff required by walking epidural.”

Dr. Cohen added that the increased use of cesarean delivery—nearly 45% of laboring women in New Jersey now undergo the surgery, he said—makes it more difficult, if not impossible, for obstetric anesthesiologists to offer patients the walking epidural approach.

Others in the field have a more tempered view of its benefits, however. “There is no ‘ideal’ epidural infusion regimen for labor analgesia,” said David Wlody, MD, chief of anesthesiology at the State University of New York-Downstate Medical Center, in New York City, and a specialist in obstetric anesthesiology. “Different patients, anesthesiologists and obstetric providers will have different expectations regarding pain relief in labor,” said Dr. Wlody, a member of the editorial board of Anesthesiology News, who was not involved in the latest research.

“Some patients may be willing to tolerate a greater amount of discomfort if it means enhanced ability to ambulate, while others will desire more pain relief at the expense of increased motor block,” Dr. Wlody added. “It is the responsibility of the anesthesiologist to balance these often conflicting goals in order to provide the best outcomes and the highest degree of patient satisfaction.”

http://www.anesthesiologynews.com/ViewArticle.aspx?d=Clinical%2BAnesthesiology&d_id=1&i=May+2013&i_id=956&a_id=23112#.UaSyPv1c7Q0.facebook

One of my favorite birth activists is the author Suzanne Arms (“Immaculate Deception”). She has always had a lot of information to offer about birth itself, but her work right now is expanding into how birth affects our larger culture. She hypothesizes that when babies are born in non-gentle and sometimes even violent ways, that this has a lasting impact on the baby, the mother, the father, the hospital staff who are present, and all present at the birth. These people go on to affect, well, EVERYTHING in our larger culture. In other words, the more gentle and more loving our birth practices, the more gentle and loving our whole society is likely to be.

I am inspired this week as I reflect on the violence in Boston to share a number of suggestions from Suzanne Arms’s website (http://birthingthefuture.org). This is an excerpt from a list of 52 suggestions that I’ve edited and added to. (You can see her website for the original list. This is MY take on her list! I have quoted her extensively here but added some of my own words.)

Have fun browsing. I will give you five suggestions today. More to come! I think that if you commit to doing ONE of them, you are helping to make the world a better place for all of us. Some of these are really fun! What if everyone who reads this blog wrote a letter a week for a year to elected politicians about birth? They would see that we care!!!! 

I’m going to start with my favorite suggestion from Suzanne Arms:

  1. Assume everyone you know is as interested in birth as you are, and act surprised if they aren’t. Assume they don’t know much but would like to, such as how they were born. After all, we were all born, and the experiences we had from our conception through birth and how our mother’s and others cared for us in the first hours, weeks and months have had a lot to do with shaping our lives. Our health, our attitude, our relationships. All of it.
  2. Bring men into the subject of birth. We were all born. Birth is not a woman’s issue alone. And how men think and feel about birth matters. Have men tell you what they know and feel about three very important subjects: circumcision, breastfeeding, and vaccinations. 
  3. Buy and donate GOOD birth books and videos (like “Natural Hospital Birth”, Suzanne Arms’s books, Ina Mae Gaskin’s books, “My Best Birth,” etc. ) to your local public library. If you can afford it also donate copies to your local health clinic that cares for pregnant teens and low-income women. Either way, be sure to ask them to carry these books and let them know they give much more accurate information than do “What to Expect…” or“GirlFriends Guide”.
  4. Write letters about your concerns regarding birth and some changes you wish to see and send it to your local/national paper, as a letter to the editor, or to local/national TV shows. Also request they do an investigative story on birth in your area or that they interview and follow a local midwife, a birth center, or a woman who’s had a home birth. Notice how natural birth, home birth, breastfeeding and bonding are often portrayed negatively in the media, including popular morning TV shows like Good Morning America and Today. Suggestion: Once a month, write a letter or get on the internet and give your thoughtful comments and recommendations to such shows.
  5. Suggest teachers you know (in elementary, junior high, and high school) learn about natural, normal birth and midwives, birth centers, home birth, waterbirth, breastfeeding and bonding (attachment). Suggest to college instructors and professor that they include issues such as the physiology, psychology, politics, economics and ecology of birth in their curriculum. (Note from Cynthia: cross-cultural birth comparisons are very interesting to students. My students at Eastern Michigan University love those lectures!) Reach out to anyone you know who teaches family life education or sex ed in high school, or human biology, women’s studies or child development and other relevant courses in junior college, community colleges, colleges and universities to get GOOD books on birth! We need to educate women early—and men too— about the biology of birth, and breastfeeding and baby care. The decisions women make about how they want to birth and whether or not they will breastfeeding, circumcise their boy baby, question standard vaccination protocol, etc, have their roots in childhood.  


I see my main job not as a doula, but as a public advocate whose mission is to mainstream natural birth. That doesn’t mean that I PREACH about natural birth (unless I am preaching to the choir at a doula or midwifery conference). I’ve found that preaching doesn’t get me very far when I am talking to the uninformed, underinformed, or people who actually disagree with me. But I do try to take advantage of situations in which it makes sense to tell positive birth stories and bring up my profession as a doula. Just saying the word can be a powerful catalyst in a room of people who’ve never heard it.

I watched it happen today, except it was not me who said the word. It was a college student, just explaining to other students in a class why he had missed class the day before.

His wife is a doula. She had been attending a birth for twenty-four hours. He had to stay home and watch their toddler.

I teach anthropology at a working-class state university in Michigan. My students are a DIVERSE group, though they are usually poorer and come from more disadvantaged backgrounds than the students at the fancy state university (University of Michigan).  That tiny spark — a man saying the word “doula” to fellow students — resulted in several conversations right there in front of my eyes. I didn’t start the conversation. I just stood there, basking in the glow of people talking about birth and realizing that there are more options than they knew. Ripples. Seeds planted.

A must-read for all seasoned and new doulas. What do you think? http://www.jodithedoula.com/2013/02/02/the-downside-of-doula-ing/#comment-564

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