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Archive for the ‘DONA’ Category

This is my little sister, being a grown-up doula! Due.Love’s first baby.

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I attended  a beautiful birth three days ago at our local, newly-renovated hospital. This second-time mother was amazing. She was so in touch with her body and what she needed to do at each and every moment: walk, sit, lie down, be in the bathtub, eat, drink, lean on her husband, visualizations for intense contractions.

Natural hospital birth requires women to be in charge of their births, and the book I wrote about natural hospital birth focuses on what WOMEN can do to achieve natural hospital birth. I chose to focus on what we CAN do, rather than on the systemic issues that we can’t control as individuals. We really can’t control the hospital staff. So women who desire natural hospital birth have to be ready to work with all different kinds of providers who have all different kinds of ideas about the best way to give birth.

Still, there are certainly ways that hospital staff can support natural hospital birth. And when I encounter hospital staff who really, really support a laboring woman I want to sing their praises everywhere! There were a thousand ways that the nurses and midwives with whom we worked last week supported this natural birth. Here I want to focus on just one of those “little” big things they did. Well, actually that they did not do. After my client was admitted to the hospital from triage, she never had another vaginal examination!

Her waters were intact and she was pronounced five centimeters when we arrived, so I expected that we would have several encounters with hospital staff about vaginal examinations through her labor. Instead, they quietly monitored the baby’s heart rate and the mama’s blood pressure for eight hours and never mentioned a vaginal exam once.

Here are some of the many other ways the staff was supportive: They never turned on the light when they entered the room. (The nurse used a flashlight to find things in cupboards.) They brought us extra pillows, extra towels, and extra hospital gowns when we asked. They pointed us toward the snack room when we were hungry. The midwife brought two glasses of water for the husband and me (the doula) during the most active part of labor, when we were working hard giving back pressure and talking the mama through each and every contraction. They were supportive in so many ways.

But by answering the mother’s questions about how her labor was progressing each and every time with a smile and reassurance that everything looked “great” — instead of saying, “Well, let’s check and find out” — they gave her such a gift of confidence. It makes me want to cry from happiness. It’s such an easy thing to do: suggest a vaginal examination. The vaginal exam, by giving everyone a “number,” appears to answer the question, “How are things going?” But, of course, it does not answer the question at all. If a woman is at seven centimeters, there is no way to know whether she will progress to ten in five minutes or five hours. There is no way to know whether she is feeling strong and capable or weak and defeated.

So often women know intuitively before or during labor that hearing a “number” will interfere with their ability to trust their bodies. (More rarely, but occasionally, some women know that they will be empowered by knowing this number. These women want to have vaginal exams and use this information to help themselves. The key is: Know Thyself!) For most women, though, hearing this cold, hard “fact” speaks to our brains, our rational selves. This is not the self who needs to be in charge of labor. Rational Self needs to step aside and let Intuitive, Body Self be in charge. There are many subtle ways that our Rational Self gets reactivated in labor. Imagine a woman in active labor who is sort of floating on hormones that take her out of normal conversational range. When the hospital shift changes and the new nurse comes on, she might come in and introduce herself and ask questions like, “So are you allergic to any medications?” She just activated the rational mind of the laboring woman! An immediate consequence of even one (much less a few!) rational thought is a lowering of our ability to cope with pain. The brain waves that allow us to be in a meditative, inner state are different from the brain waves that allow us to hold conversations. These brain waves are associated with changes in hormone levels, blood flow to various organs, heart rate, etc.

So, the fact that these nurses and hospital-based midwives were willing to forgo vaginal exams for EIGHT HOURS was a gift beyond measure. This mama got to labor and remained the expert on her labor. Her bodily sensations, her noises, her movements guided how the rest of us acted. We did not ever try to push her to get labor going “more” or “better.” No one had to feel disappointed or worried about how much longer there was to go, based on a number we heard at a particular moment. We all got to focus on a woman in labor. What did she need? What helped her feel the most comfortable?

When the baby arrived, she pushed twice. The baby arrived happy and healthy. I assume she had made it to “ten.”

What was your experience with vaginal exams at hospital births?

 

 

 

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It always feels so awesome to feel like you’ve made a difference in someone’s life. I met Heather Boyd last year as a student in one of my classes at Eastern Michigan University. I always offer “alternative” projects in my classes and in my medical anthropology class that fall I said that students could take a training program in becoming a doula, homeopath, herbalist, etc in lieu of a final paper. Heather took me up on the idea and became a doula that semester. She told her classmates all about the first birth she attended. I think they were all a bit in awe that she was out there, supporting a family at a hospital birth, while they were researching things like ADHD treatment in on-line journals. Last semester, she and two other students helped collect over 200 letters to representatives in support of Michigan midwives. This year, Heather is creating a non-profit “Students For Midwifery” and writing a workbook for teens who are pregnant. Check out her project on RocketHub and consider donating what you can. Twenty-five dollars? Ten? Five? It all adds up to better birth. http://rkthb.co/4703

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The Birth Interview Project | Mary’s Natural Birth in a Stable. 2000 Years Ago.

Whether you are Christian or Muslim, Jewish or atheist, I think you will find something to enjoy in this light-hearted look at natural birth in a stable. Of course there was a midwife at the inn! 🙂 Isn’t all birth so meaningful and such a beautiful way for us to connect with Whatever Is Larger Than Us in the Universe? I loved this post and hope you will, too!

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Hire a doula to avoid an induction!

There is an epidemic of inductions occuring in the United States and Canada right now. The Listening To Mothers II Survey found that, “More than four out of ten respondents (41%) indicated that their caregiver tried to induce their labor. When asked if the induction caused labor to begin, more than four out of five of those women (84%) indicated that it did, resulting in an overall provider induction rate of 34%.”

(You can read more about it at http://www.childbirthconnection.org/pdfs/LTMII_report.pdf)

At the end of pregnancy these days, there are a host of potential reasons your caregiver might suggest an induction. UNLESS YOU HAVE SOMEONE TO TALK TO about it, you are likely to go along with the suggestion. Think about it: at 38 weeks, most of us feel DONE with being pregnant. We’re ready to meet our babies! So when someone offers to make that happen, like, tomorrow, it’s hard to resist. Especially if they add a medical-sounding reason to the idea.

But the fact is that most women do not grow babies too large to birth and most women have plenty of amniotic fluid. But these reasons to induce are offered to many, many, many women nowadays. It’s just not possible that 41% of North American women have suddenly developed narrower pelves and have less amniotic fluid. We have more information (like estimates of amniotic fluid levels) because of more technology. But more information is not leading us to make better decisions. Instead, our caregivers feel compelled to give us the information and the “worst-case scenario” associated with that information. That worst-case scenario is likely to sway us toward induction.

But if we are able to wait a few hours, breathe, relax, think it all through, we can make the decision that is right for us. Of course, there are some situations that call for an induction. But there are many, many more that do not.

Here’s where your doula comes in. Your doula will not be able to give you medical advice and she will not be able to make the decision for you. But she can offer help in YOUR decision-making process. She can ask questions. She can point you to resources. She can connect you with other women who have faced similar dilemmas who might be willing to share their wisdom. She can tell you stories. She can suggest a long list of natural induction methods you might try before going the medical route. She can guide you to think through how you might feel if this induction turns into either an epidural or a cesarean.

In short, she can help you make your best decision. It might be that the best decision is to induce. It might not. However, talking your decision over with your doula — someone who knows your birth plan, your birth vision, your birth dreams — will help you have peace of mind.

I run mom-and-baby groups in my hometown. So many new mothers come to our group with great sadness and regret about how their labors went. They say, “If only I had known…” a lot. A doula is like insurance against regret. She helps you make your decision fully and consciously so that, no matter what happens later, you have confidence that you made the right decision to begin with.

[P.S. Why does avoiding an induction matter? Because when women are induced, a host of other interventions often follow (called “The Cascade). A common drug for induction, Pitocin, makes contractions feel more painful. FOr a woman planning a natural birth, this can really get in the way! But even for a woman planning an epidural, Pitocin contractions in early labor can be a problem. If you get an epidural before active labor really kicks in, your labor can be long and slow. But if you wait until active labor is really going, you will probably have to weather some significant, unplanned-for pain. In other words, no matter what kind of birth you are planning, Pitocin gets in your way. (If you want to read more about this, I refer you to either Henci Goer’s book “The Thinking Woman’s Guide to a Better Birth” or my book “Natural Hospital Birth.” Both of these books talk about Pitocin in detail.)

Another important reason to avoid induction is that the rise in induction rates corresponds with a rising rate of babies born prematurely. If our dates are off (which they often are!) we could be asking our babies to be born a few weeks too soon. Nature has a fabulous plan for your baby’s birthday. Let a doula help you avoid an unnecessary induction and discover your baby’s “real” birthday!]

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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. I happen to know the woman who is doing this project personally. She’s a young, inspirational college student trying to help teenage moms. She became a doula last year. Check out her project at rockethub and make a donation in the name of your favorite doula! http://www.rockethub.com/projects/4703-teen-pregnancy-help

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!

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Hire a doula because…

She will come to your house. None of the rest of your hospital birth team will do that.

If you are planning a hospital birth, one of the hardest decisions is “when to go to the hospital.” Your doula will come to your house in early labor and help you decide when is the right time to head to the hospital. Believe me, you will trust her judgment in this far more than you will trust your partner’s (unless s/he happens to be a birth professional!). This important decision can affect how you how your labor progresses and how many interventions you may encounter.

Most women go to the hospital TOO EARLY in labor! There’s nothing worse than getting sent back home in early labor.

Why do we go to the hospital too early? Because we all want to believe that we have progressed further than we have. When we have experienced labor for three hours, we want to believe our cervix has dilated to eight centimeters and delivery is immanent. However, especially for a first baby, this is unlikely.

An experienced doula can gauge your labor progress better than you can (unless you are an experienced mother). That’s not to say she knows your labor better than you do, but she has seen and heard other women in labor. She knows what active labor sounds like and looks like. It’s quite distinctive. There are some women who do not fit the usual pattern, certainly. But in my experience as a doula this is rare. Active labor sounds surprisingly similar for most women! I know midwives who can diagnose active labor quite accurately from listening to women during contractions on the phone. Having a doula help you decide when to go to the hospital helps you avoid getting to the hospital too early.

Why Going to the Hospital in Active (Not Early) Labor is a Good Idea:

Hospitals do not like to admit women before they have reached active labor. The hospital staff, and your doula, know that if you are in early labor you are more susceptible to having your labor slow down (sometimes slow WAY down!) if you change locations. Because we are mammals, our bodies are designed to slow or stop labor if we need to use our brains. Our bodies cannot tell the difference between having to use our brains to figure out how to escape a hungry lion and having to use our brains to answer the triage nurse’s questions. Either stimulation can cause our hormones to change and our labors to slow down or stop.

This is less likely to happen once we have made it to active labor (defined loosely as the cervix dilated to around 5 centimeters). Then, hungry lion or not, our baby is probably going to come pretty soon.

It is especially important to arrive at the hospital in active labor if you are planning a natural hospital birth. The later you arrive, the less time there is for interventions! If your labor is progressing at a leisurely pace, you do not have to worry about beating a clock or losing a favorite nurse at a shift change when you are at home.

Your doula helps you decide when it is the right time for you to get to the hospital. She knows what kind of birth you are planning and she can help you optimize your chances of achieving the birth you want.

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Hire a doula because, when all is said and done, she is the only one at your hospital birth (besides your family and friends) who answers to you as her final boss.

Your midwife, doctor, and nurse are probably wonderful and probably they want to help  you achieve the birth you want. But midwives, doctors, and nurses who work in hospitals have to answer to a lot more people than just you. They have to answer their colleagues. If they manage births in an unusual manner, and in today’s world, “unusual” may mean “more natural” just because of the statistical realities of interventions, their colleagues can exert subtle or not-so-subtle pressure to get back in line. And they have to answer hospital review boards and insurance companies. Insurance companies have a lot of impact on our medical institutions. Since obstetricians are the most-sued doctors in America, you can imagine that insurance companies care how they are practicing!

But doulas do not answer hospital review boards or insurance companies. They answer to mothers. Doulas are there for mothers. It is their entire job. One hundred percent. They do not have to spend time during your labor inputting lots of data into computers. They are focused on how you feel.

So it is definitely a good idea to make sure that your entire birth team is on board with your birth vision. It’s a great idea to make sure your care provider can handle whatever comes up (even if that means transferring your care. Transferring is still great care.). But it’s also helpful to hire someone who answers only to you. When you look in her eyes for reassurance in your decision-making process, you can be certain that she is reassuring YOU. She is helping you make the best decision for YOU.

Do you have any stories that exemplify this? I’d love to hear them!

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Reason #2: The Five Minutes You Will Remember Forever if You Don’t Have a Doula

Some pregnant couples hire me and I know throughout the pregnancy that I have been a valuable resource to them. Others hire me and I don’t do much during the pregnancy, but I play a crucial role during labor. And still others hire me and I do very little for them during pregnancy or labor. They are well-informed, well-prepared, and labor goes smoothly. Mom and her partner are tucked away in a private world I can barely touch. I am basically superfluous.

Yet sometimes even these couples get their money’s worth from hiring a doula. They can get hundreds of dollars of value in just five minutes. I have learned over time that one of my most valuable gifts to new parents in a hospital setting (and even, once, at a homebirth) is the connection I can facilitate between mother and newborn in the first five minutes of the baby’s life. Unfortunately, at many hospital births, no matter how natural labor might have been and no matter how dedicated to natural birth the parents might be, babies are often whisked away from the birth canal straight to a warming bed across the room. Sometimes the reasons for this are clear (such as the presence of the baby’s first poop, called meconium, during labor, which must be prevented from entering the baby’s lungs) and sometimes the reasons are not at all clear. The problem, however, is that the new parents are virtually powerless. Worse, they are scared.

That’s what I mean by the “five minutes you might remember forever if you don’t have a doula.” Because when babies get taken across the room to be “worked on,” usually there is no explanation given but there is a ton of fear. All medical attention in the room is on the baby, the mother’s uterus, and the mother’s perineal area (managing the birth of the placenta, getting ready for stitches, etc.). Because the nurses and neonatal team may intend to keep the baby only for a few minutes, they do not think about how those five minutes feel to the new mother. The nurses and doctors are extremely busy in those minutes: measuring, assessing, rubbing, using a syringe or other tools to clear airways, etc. These professionals are probably experiencing time as rushed. The new mother, across the room, however, is likely experiencing time in quite the opposite way. For her, these moments after hours of contractions and pushing feel like openings onto eternity. If she does not hear her baby cry and see her baby move, she can panic. Those five minutes can be full of the worst fears of her lifetime: her baby has been born dead. Mutated. Not human. She will never hold this baby alive. If there is silence, she may hope for the best, but some animal part of her that is supposed to be soothed by touching her newborn will pull up the ancient fears of death-at-birth.

Knocking on wood, all of the babies I have watched wiggle into this world have been born alive. But many of them needed some help in the first few minutes to adjust to breathing air, pumping blood through their hearts, and feeling comfortable in our world.

So, in those critical first five minutes, I have given myself the task of narrating the baby’s life to the mother. If the baby is taken away from Mama, I stand somewhere in between the two and relay details of what I see. “Oh, I see your baby’s feet kicking! Oh, this baby looks mad that these nurses are cleaning him off!” I say. Or “Oh, your baby is so beautiful! She has so much gorgeous hair (or she hardly has any hair, but I think it’s brown).” Or “You probably can’t hear him, but your baby is making some noise over here! He has something to say about what’s going on.” Anything. Anything at all. Anything concrete about this new child. I try to convey a sense that this baby is here, this baby is alive, this baby is a person.

This fulfills two purposes simultaneously. I do this narration for the mother, so she can focus on the details I am describing and not on her fears. She may, this way, avoid the worst five minutes of her life, worrying needlessly that her baby is not all right. Secondarily, this narration affects the hospital staff. It reminds them that the mother is waiting, WAITING!, for her baby, and that getting the baby back to the mother is of utmost importance. I like to believe that this narration — this reminder that a human mother is waiting to meet her new child — helps the staff put off the unnecessary tasks (like weighing the baby, washing the baby’s skin more thoroughly) until later. If the baby’s life is not in critical danger, s/he belongs with Mama. Everything else can be done on her chest or it can be delayed.

I have found this process to be equally helpful whether I am attending a vaginal birth or cesarean birth. If I cannot be in the room at a c-section, I often pull the father/partner aside and suggest this idea. The new mother on an operating table can feel even more helpless, even more scared about how her baby is. She needs instant reassurance that her baby is real, her baby is here, and she will touch her baby soon.

As doulas, we can sometimes prevent babies from being taken away from their mothers in the first moments of life. But we can always, always commit to narrating this time. Most of the time, doulas do a lot of important work prenatally and during labor. But I think we can earn our keep, even if this is practically all we do. Have you ever been in this situation?

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Reason #1: A doula can relieve your partner in a long labor. Sometimes the tasks required of a partner during a labor can be impossible without backup support from a doula. A labor that lasts through several mealtimes or all your normal sleeping hours can wipe out not only mom-to-be, but her support team, too. Doulas can allow partners to take 20-minute naps (or in really long labors, two or three hour naps) and visit the bathroom without being worried about leaving you alone. I once played back-up doula for a long labor in which the first-line doula AND the father needed relief. They had been supporting the mom-to-be for almost 36 hours straight and neither the doula nor the dad had slept for more than about 30 minutes. I came in the middle of the night for a four-hour relief stretch. I barely knew this couple, but I slipped into the dark room and quickly learned how to give back pressure the way this laboring mother needed. Her doula and partner went to the lounge to sleep. Mom and I worked together without saying much, just in the rhythm of labor. She was handling her contractions well; she was just exhausted. She, too, slept in between sensations. At dawn, the doula and father returned and I said good-bye. The doula and father agreed to take one-hour shifts after that so that they didn’t burn out. The baby was born, healthy and beautiful, about six hours later.

As a post script to this story, I ran into this woman two years later and found out that she had become a doula herself. She said she was so amazed at the support the two of us had given her and her husband that she wanted to give that gift to other families. She gushed about how incredulous she was that I had come in the middle of the night to offer relief to her support team. It was nice to hear, but it was also easy to say, “That’s what doulas do!”

BTW: here’s a link to a “10 Reasons To Hire a Doula” article by Ann Douglas. They are all good reasons. Excellent reasons. But I am going to try to write down the “other” reasons here in this series. The reasons that it’s GREAT to have a doula, but that most people don’t think about until after the fact (or, often, until it’s too late!): http://www.ohbabymagazine.com/prenatal/why-doulas-are-a-moms-best-friend/

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