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This is a quick reflection on how birth is about “the unexpected” and about how important it is that women be in control of decision-making in birth precisely BECAUSE so much in birth is unexpected.

I think there is nothing worse than expecting one thing, having something entirely different happen, and feeling like the decisions were not in my control. Yet, this is what happens in birth across America every day.

We all have some vision in our mind of how our “perfect birth” will go. And I have yet to meet the woman who achieved her vision 100%, although I’ve definitely met a lot of women who are happy with their experiences. I’m always amazed at how even women with seemingly perfect births can obsess about the things that did not go right! (That’s a post for another day, because, come on! Let’s start talking about what went RIGHT at our births!) But this post is not about those seemingly “perfect” births.

It’s about the births in which we’ve planned really well, we’ve hired just the right support team, we’ve done everything we can to ensure that our vision has the best chance to succeed…

and then the baby decides to turn her head sideways or come out foot-first

or there is a flood/tornado/hurricane/outbreak of SARS (that last one happened to friends of mine who gave birth in Toronto!)

or our midwife is sick

or our blood pressure gets dangerously high during labor

or whatever….

And we have to improvise. We have to make decisions that we wish we didn’t have to make. We accept interventions because we know they are the right thing to do in the moment, but we also know that we researched and planned for HOURS and WEEKS and MONTHS to try to avoid them.

It’s just so important that women have as much decision-making control (and support) in birth because when these scenarios arise we will feel so differently about them when WE said, “Yes, it’s time for that intervention” than when we felt like it “happened to us.” Our healing for the days, weeks, and months after the birth will hinge in many ways on whether we feel like we had no choice or whether we chose.

We may be sad and angry that we did not have the perfect birth we envisioned, but we will not feel tricked, disempowered, or trampled upon. We can be sad and angry and also, simultaneously, grateful and empowered. These do not have to be mutually exclusive.

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So, I wish I wrote this about the cesarean rate. And I wish I made all the great graphics to go with it. But, even though I didn’t write it myself, I’m in love with this piece. It’s really helpful for answering the question I get all the time, “So, why do you think the cesarean rate is so high?” I can talk, talk, talk about all the reasons, but this piece just quickly runs through the reasons and more importantly gets to WHAT WE CAN DO actually.

Let’s get to it!

http://www.toprntobsn.com/bringing-birth-back/

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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.

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Reposting my all-time favorite post. Because I love my job! Every so often I get a bug to become a better-paid birth professional. Doulas are just not the top earners in the birth field, sad to say.

And part of me is a real midwifery geek. I know I would love learning to become an obstetrician or a midwife or a labor and delivery nurse. I love learning about blood vessels leading to the placenta, about how to guide a breech baby out, about how to diagnose an ectopic pregnancy. Really. GEEK is the only word for the thrill I get from reading about such topics.

But when I am at a birth (as I was a few days ago) I have this fabulous role. This birth brought it home. Everyone else in the room at this hospital VBAC birth was focused on getting a recalcitrant baby out of a woman’s body as fast as possible: cutting her vagina open, attaching vacuum suction cups to the baby’s head, and adjusting various accoutrements to keep track of the baby’s heart rate (which was low and not coming up in between contractions… thus the drama and concern).

In contrast to the midwife, the L&D nurse, the obstetrician, the resident, and the neonatal team, my job was to remain full of trust in birth. My job was to help the mother stay connected to her calmest, most trusting place inside herself. I was allowed to smile and tell the mother that we could all see dark, curly hair as her baby’s head crowned. Everyone else was 100% focused on getting this baby’s head OUT. Fast. The mother and I were able to concentrate on this baby’s individuality. (Her previous babies had blonde hair.)

When the baby was born, the neonatal team whisked him away because of the heavy meconium. (Yet he was FINE immediately. At one minute he had an Apgar of 8. So much for all the panic!) No one but me noticed that the mother was panicked without being able to see or or hear or touch her baby.Of course, after all that drama when she didn’t hear a cry right away, she was afraid her baby was not OK. I was able to stand in the middle of the room and relay news about how her baby was waving his arms and legs and his skin was a beautiful, healthy pink color. All the birth professionals were busy, with important jobs for which they went to school for many years and for which they get paid fair salaries.

But would I rather learn how to measure a cervix or help a mother find her inner power? I am so, so glad that there are birth professionals out there who answer, “I want to measure the cervix.” Without these professionals, birth would not be as safe as it is today. Yet I am happy when I remember that my greatest joy is not measuring blood pressure or fetal heart tones, it is in aiding a woman have the experience that makes her feel like she is a powerful, amazing mother who can do anything. This is a feeling she gets to keep for the rest of her life.

Helping women smile when they remember giving birth. That is a doula’s job.

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I just read a blog by a woman who was trying to decide whether to hire a doula in her second pregnancy. She eloquently captures that inner dialogue that I bet a lot of women have about this question: Is a doula a luxury or a necessity? In her blog post, she talks about her unease with consumerism. Do we need to buy things to be happy? Do we need to spend money to regain our confidence in our own birthing bodies? You can check out her blog here: http://mothershavefeelingstoo.wordpress.com/2012/08/29/doulas-necessities-or-luxuries/

In this post, I want to offer one idea in response to the Mastercard-buy-more-to-be-happy-consumerist problem we all live with in the First World. One of the problems with consumerist culture is that we mistakenly believe that the THINGS we buy are what gives us pleasure. In fact, the things we buy are things that real humans made, transported, sold. It is their WORK that gives us pleasure. When we buy services (massage, health care appointments, a haircut, or doula services) this is more evident than when we buy objects.

When we remember that it is human’s work that we are paying for, not just “things,” we can make wholly different choices about spending money. We can spend money and stop being a “consumer” if that makes sense. We can USE money to connect with other humans. So often we do the opposite. We use the fact that we are paying someone money for something like a haircut or cleaning our house or taking care of our children as an excuse to treat them differently than we would a friend or relative. We all do it. (Be warned: Sometimes when I try to treat someone I am paying for a service more humanely than they expect, they act as if I am crazy.)

As a doula and as a woman, I value so-called women’s work — no matter who does it, men or women. Long ago as a teenager learning about women’s work in history I vowed that I would pay childcare workers fairly even if they themselves did not charge a fair amount (which is true in our area. Our babysitter charges an absurdly low hourly rate and doesn’t charge for sick days: hers or ours!). A more accurate term I learned in graduate school is “reproductive work” — which is all the work that is (usually) unpaid if it happens within a family. It is the work that is necessary to reproduce ourselves everyday (taking a shower, mending clothes, cooking, doing dishes, gardening, etc.) and to reproduce another generation (childcare, etc.)

Because of larger cultural and global forces outside of any one person’s control, we are not able to do all the reproductive work inside families anymore. In my case, a big factor is that my parents, my husband’s parents, and all our siblings (eight in all) live far, far away from us. The closest is a ten-hour drive; many of them live across the globe. Many of my friends rely on their extended family for SOOO much help. My best friend here sends her two kids to her in-laws overnight every Saturday. [An aside: I can’t imagine having a night off of children to spend with my husband free of charge every week. When we do hire a babysitter, we have to go out of the house. I would love to stay at home and sleep at home with my husband with no kids in the house!] Just because I would prefer to have much of this reproductive work done inside my family networks doesn’t mean that is the best way to do it in 2012.

In general, I try hard to be thoughtful about using money and when I pay for reproductive tasks I find I am even more thoughtful than when I am buying plain-old commodities like new running shoes. I want to be thoughtful when I am buying running shoes, too, but I find it is easier to be thoughtful when I actually meet and interact with the human who is doing the work. Because when I pay for reproductive work (cooking, cleaning, childcare, doula work) I am asking someone to step into the shoes of my relatives. I am asking someone to care for me/my loved ones. Money is just the vehicle that allows someone else to have the time to do this work that I do wish my sister, my mother, my grandmother could do for me. But they can’t. So I am using money as a tool — not a substitute — for connecting to real humans.

It’s not a perfect solution to our consumerist culture. But being clear that money is really a metaphor for human time and that what we buy is human work — not “things” — makes me more thoughtful about my choices. And the surprising conclusion I come to when I think this way is that I want to spend MORE of my money on things like doula services and home-cooked meals and less of my money on things like technological gadgets.

What about you?

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I got to speak at University of Michigan on Saturday to a packed room of what looked like 100 people or more. Wow! There were nurses, midwives, doctors, doulas, and pregnant women conversing together. Again, wow! It’s so great to be HAVING these conversations. Here’s an article from the University of Michigan website:

Hospital can provide safety net without pushing interventions; expert panel discussion planned at U-M March 24

Nadine Naber labored with a midwife, who guided her through her pain. Her husband was at her side, holding her hand, as she gave birth to her youngest son in a water-filled tub.

It was everything she dreamed a natural childbirth could be. But it didn’t happen at home — her son was born in the hospital.

Naber is one of many women who find that a natural hospital birth — a childbirth without medication or other intervention — is possible at Von Voigtlander Women’s Hospital at the University of Michigan. U-M has eight nurse midwives on staff and encourages women to set a natural birth plan that still offers the advantages of being in a hospital setting.

“I truly and deeply experienced what I would dream of with a natural birth, in every way possible, without any sense of it being medicalized,” says Naber, a 42-year-old mother of two and Ann Arbor, Mich. resident.

Naber says the natural hospital birth offers the best of both worlds: a birth plan without unnecessary medical intervention but also the safety net of the hospital setting.

U-M and Douglas Care will host a panel discussion, “Supporting Natural Birth in Hospital Settings,” on March 24, featuring author and professional doula, Cynthia Gabriel. Gabriel’s book, “Natural Hospital Birth: The Best of Both Worlds,” features a forward written by U-M’s Timothy R.B. Johnson, M.D. , who is professor and chair of the U-M Department of Obstetrics and Gynecology.

 http://umhsheadlines.org/20/natural-births-possible-encouraged-in-hospital-setting-at-university-of-michigan/

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Dear Doulas,

My sister recently attended her first two births as a professional doula! (See her at https://www.facebook.com/DueLove?sk=wall) I am happy to say she was also MY doula when she was fifteen years old and I was giving birth the first time. AND she attended our niece’s birth when she was only twelve, I think.

It made me remember those wonderful days of beginning down the doula’s path. I was full of passion and fire. I was really jazzed about women’s power. I couldn’t wait to attend LOTS of births. I was ready to be awake all night. I was so ready, in fact, that when my second birth was imminent, I couldn’t sleep for days BEFORE the baby arrived. And that labor turned out to be two days long. Rookie mistake. 🙂

I wanted to write to my sister, and all the other beginning doulas out there, to share something I’ve learned over the years to avoid burnout but keep up my passion. I heard it first from my doula instructor Ann Fuller, but it didn’t sink in. Then I heard it from a midwifery teacher, Elizabeth Davis, but it didn’t sink in. Then I learned it from a wise doctor in Russia and she said it just differently enough that it finally sank in.

Ann Fuller said: “When you attend a birth, remember you are not the one giving birth.”

Elizabeth Davis said: “When you attend a birth, remember you are not the one giving birth.”

Still, somehow I managed to feel disappointed, as if I had failed in some way, if my clients did not have what I considered “perfect births.”

Finally, about a year into being a doula, while I was working in a Russian birth hospital, I was lucky enough to hear a Russian doctor say, “It helps me if I assume that the Universe gives every woman and every baby exactly the birth they need to learn the lessons they need to learn in this lifetime.” Wow. That shifted my thinking. She later told a group of Americans who were complaining about the Cesarean rate in the United States (in 2000 it was at 25% and we were complaining. Now it’s at 33%) that she believed that, while the rate was high and we should all do what we can do to lower the rate, she preferred to think of it a different way. She said, “What if most of the souls who need the lessons of a cesarean birth are choosing to be born in America?”

I do not use this rather “spiritual” thinking to justify unnecessary interventions in birth. I use a different part of my brain, a very rational part of my brain, when I am analyzing cultural patterns and medical statistics. When I write and talk about larger cultural patterns, I think it is appropriate and useful to access anger and outrage.

But when we are talking about an individual’s experience, I find that accessing this spiritual, zen-like, accepting mode of thinking helps me. I can focus on learning lessons from the experience, rather than kicking myself for failure. Believing that a woman’s labor went just the right way for her and her baby helps me bring a softness, an acceptance, a respect for what she actually, really experienced. I can honor what really happened instead of focusing on what “should have” happened.

And, best of all, I can work as a doula without carrying the weight of the world on my shoulders. I can help women and families. I can rejoice when births go “perfectly,” but I can also rejoice when they go less than “perfectly.” I am better able to focus on the power, strength, and effort of women (and their families) and I am less likely to focus on the negative.

Please do not misunderstand me. I believe that COLLECTIVELY we must focus on improving birth in America. But not at the expense of burning out doulas, midwives, nurses, or doctors. And definitely not at the expense of blaming individual women. If women do not get the birth they truly desire, I automatically blame what surrounds them: a culture that says pain is bad in all forms except perhaps sports, a culture that turns to pharmaceutical solutions far too often (not just in labor), a culture that makes birth sound terrifying and awful, a culture that does not honor the work of women generally (or the family work of men, for that matter).

But accepting each individual birth as perfect just as it is, that is good for my soul.

Thank you for doing the work you do, doulas!

Yours, Big Sister Doula

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