The excitement that surrounds an expectant mother starts building as soon as the good news is shared. As her burgeoning belly grows, so does the attention from others. Baby’s arrival brings relatives, friends, and neighbors…at first. But as the much-awaited birth comes and goes, so do the people. Often this can leave a new mother feeling isolated, tired, and depressed.
In some cultures, the new mother is relieved of her daily duties and attended to for up to 40 days postpartum. Special restorative foods are brought to the mother, she is taken care of by members of her family, and her sole responsibility is to bond with her new baby. In our culture, 40 days after birth typically sees the end of a mother’s maternity leave!
You can help meet a new mother’s needs simply by using your heart and your hands, and sometimes your ears. Never expect to just plop in and be entertained – always ask what you can do to help. Often mothers have reservations about letting you pitch in with cleaning or laundry. If this is the case, place a simple list numbered 1, 2, 3 on the refrigerator. Ask her to write down three things she would feel comfortable accepting help with. The next time you visit, glance at the list and get going! If she insists life is great, do something unexpected for her. Bring her a pot of homemade soup and some warm bread. Drop off a new pair of pajamas for her, or the baby, or both! Demonstrate your active listening skills by using attending body language and summarizing her shared feelings; suspend your judgment and offer suggestions only if she asks for your opinion.
I have the fortunate opportunity to nurture and support women of the Bakersfield and Visalia areas during their experiences of pregnancy and birth. I have noticed the mother who functions well, feels good, and exudes confidence early in the postpartum period is the mother who continues to be blessed with help and visits from her extended supporters. Babies bring joy, but they bring demands as well. By meeting the needs of the new mother in your life, whether she is a friend, a neighbor, or your own daughter, you are enabling her to better care for and meet the needs of her own baby.
Three things that can help after the baby comes:
Did you know, those fabulous statistics we read about regarding "continuous one-to-one emotional support provided by...a doula," don't diminish if the person in labor also happens to be a doula? That's right! Even doulas hire other doulas, because we know EVERYONE deserves a doula -- even a doula. Are you tired of the word doula yet? Because it happens to be World Doula Week, and I am pretty positive the "d" word will be prolifically used herein -- fair warning! Now, settle back and read why doulas choose to have that unique support and help only doulas bring to birth.
Other reasons are longer, and they still make a lot of sense:
"Preparing for my fifth baby I considered a doula. However, my husband has been such a great support and I found myself using all the common reasons not to have a doula. I worried it may interfere with the dynamic between me and my awesome, supportive husband. I worried about expense. I also have precipitous labors and didn't know if I'd be able to make it to the hospital, much less if my doula would make it. I spent much of my pregnancy helping my own doula clients plan their births. Yet I struggled to focus on my own. Finally I realized that I needed some help to focus and plan on my birth. Talking with my doula was invaluable. She helped calm my fears and work through trauma from a previous birth. I still didn't know if she would be able to make it in time but having her help me prepare and knowing she would be there to help me process afterwards was a big comfort. I also knew that I could use all the hands I could get for counter pressure. When my birth came, it was longer than expected. It was wonderful to have someone that knew what I meant when I asked for different counter pressures or rebozo techniques. She read my mind so I didn't have to verbalize each step. I was able to hold onto my husband while she gave counter pressure -- to hug him while still having the comfort measures. In transition I was grateful for multiple hands providing relief. I have birthed four times without a doula. I have supported countless families as a doula myself. However, having a doula for my fifth baby, I will never personally go back to not having one again. There is always a use for one. You never know what may happen or how useful a doula may be."
-Becky Hartman is a doula, photographer, and energy worker in Davis County, Utah. She just birthed her 5th baby this past week, so this is all fresh in her mind! To learn more, visit her website and go "like" her Facebook page.
Sometimes the decision seems made for you:
"I didn't actively choose to have a doula for my births -- it just happened that the universe provided them. They were just the right amount of hands-off until absolutely necessary, and then hands-off again -- which is exactly how I work. I felt so relieved I could let myself fall into the network provided for me by my community. I'm eternally grateful to these women who gifted me their work, both emotional and physical! My midwives through the years have been amazing support, as well. There's nothing I would change about my births, thanks to their skilled care."
Bryna Sampey is the creator behind the Portland-based Doula My Soul. Always about community, she and the others at Doula My Soul offer birth and postpartum doula support, breastfeeding help, classes, and more.
Seeing mom working so hard to bring their baby out? Making noises that seem more appropriate coming from a howling monkey instead of a human? Watching things that maybe one has only seen on Discovery Health Channel through half-closed eyes? The blood, sweat, and tears of it all? Does that answer your question?
Birth is an amazingly transformative event in the life of the family. As a doula and an educator, of course I relish in the whole thing and view baby's emergence as a spiritual experience unlike any other. I am comfortable with the noises of labor and the sound of hard work -- the music which accompanies this great act. Not everyone is, though, and not everyone feels sure about the birth process and the safety of their partner, the laboring person.
My husband and I have been married 21 years. On our 11th wedding anniversary we found ourselves seated across the table from each other at a Chinese food restaurant. At this point we had three of our four boys, the youngest just a year old. I decided to start the conversation.
"I want us to think about our time together, and take inventory of our relationship, our family, and our lives." My husband suddenly looked like a he walked into a pop quiz. He didn't look eager to answer my probing questions. I was joking, but this did lead to one question that had been on my mind lately: "Well, answer this for me -- did you enjoy being at our babies' births, or would you have rather waited outside until it was over?" Being a birth-lover, I knew what answer I wanted to hear -- did I have it within me to hear the other answer, too?
"Honestly, I would have liked to come in when it was all over." I did kind of know this, I don't know why I was expecting to hear that other answer. I love my husband, and to his credit, he never left me needing or wanting more during labor; coupled with my doula's support, he was my main pillar of strength. I know he appreciated my doula's way of caring for me, of anticipating my next whim, of comforting not only me, but also him.
The realization set in that labor and birth is not everyone's cup of tea.
I have seen partners, unsure in the beginning, actually put a glove on and check Mom's cervix (with the help of a wonderfully encouraging midwife). I have seen a dad be the first to touch his baby's little head as it peaked ever-so-slightly out. I have even seen a baby tumble out into a dad's strong hands. But a partner does not have to do any of that to be involved and to show his or her love for the laboring person. Hands are important, but the location of hands is not. Hands on hair, hands on forehead, hands on back -- hands on hands -- can be accomplished by a birth partner at any comfort level. Touch is the goal -- touch and loving words.
In my husband's case, he held my hands during the most intense parts of labor, and he encouraged me with his voice; sterile gloves were not needed for either.
There is such emphasis on what to bring to the hospital -- you can find a hundred lists on Pinterest and other places. While we try to anticipate what a laboring person will need, inevitably, something may be forgotten. Here's a handy list of things you may already have access to simply because you are in the hospital.
Every doula learns her own tricks according to the laboring person's needs, the hospital's set up, and the nurses' suggestions. It's always a good idea to ask before you go searching in drawers and cupboards. But I have found, if you have a need or an idea, the staff is supportive of out-of-the-box ways to comfort someone in labor. What has worked for you?
(I love this picture -- these are some of my fellow doulas in the Bakersfield, CA area.)
For three years now...
I have hosted a celebration of doulas on my blog. The original idea was something I thought of, literally, on April 31, 2014. I was struck with the idea of trying to feature 31 days of guest posts written for doulas, by doulas, or about doulas. International Doula Month is every May, so this didn't give me much time to act! I quickly contacted a doula friend who had recently shared a blog post about all the things she learns at births, and that was Day 1 of 31 Days of Doulas, 2014. As the days progressed, I sought out other pieces, either crafted for this project, or previously written, to feature on my blog. This was overwhelming to tackle, but so rewarding! So rewarding, in fact, that this project carried into 31 Days of Doulas 2015, and 31 Days of Doulas 2016.
Sometimes doulas or families approach me with a piece to share. Sometimes I know something of someone, and I ask if they would consider contributing an original essay or article to the project. I have also stumbled upon other blog posts related to doulas, and sought permission to repost them on my blog. My most favorite thing ever about acting as editor in this role is when I know there is a story in someone, and I can encourage them of its value and help bring the words to life, now having meaning for someone else -- people who never thought they could write, people who never thought anyone else would care to hear that story -- proud of what they created and pleased to see how that helps others.
Because I love to blog, I created a Facebook group Blogging About Birth. My intention is for this to be a place where birth workers can share ideas, new bloggers can be mentored and buoyed up, and experienced bloggers can be challenged and revived. I love seeing what members share and what projects they are up to.
Each year I prepare a little earlier, because the 31 Days project is a hefty one! Generally I spend one hour a day editing, formatting, putting together the layout, creating or procuring graphics, linking, posting, and writing introductory/closing remarks for each post -- and that doesn't factor in the time connecting with the various authors. If I am lucky, I can stay one or two days ahead of schedule, and beg, borrow, or steal from friends and people I know if contributions are coming up short.
I am always looking for posts that relate to doulas -- if you are interested, please, let me know! And now, I end stealing words I wrote to close out the first 31 Days of Doulas: "At this point, I feel I am out of words! I can only say amazing so many times to describe this project. I am grateful for all I learned. I am grateful for the help you gave when you participated. I appreciate the time it takes to dig deep, sort, and get it all out on the computer screen. Thank you. I have learned so, so much from all of you.
All you Doulas out there, keep loving and serving families and being shaped by your experiences. And when you get a few minutes, don't forget to write."
Some of my favorites from past years
We are pretty familiar with Birth Plans, right? When it comes to what to do before it's time to head to the hospital, that's where an Early Labor Plan comes in.
One of the most powerful tools we have as humans is the ability to be distracted. Distraction is often thought of as a bad thing, but there are times in life when distraction is beneficial. For me, I can't say how many times I have been teaching a great group of future parents, only to realize, once class is over and the excitement dies down, that I have a monster headache! And in there somewhere at the edge of my consciousness, I knew I had a headache; I wasn't giving it attention, so it didn't bother me.
I heard once from a nurse I worked with that families, on average, go to the hospital 3 times before it is time to stay...I should clarify, 3 times before it is medically time for them to stay because they are actually in the phase of labor where the hospital will accept them. What often happens is the family, or the hospital, produce a (non-medical, or near-medical) reason to stay, which can mean interventions are now on the table to help things go faster. A secret about hospitals? They don't want people hanging around, not having babies, so the pressure to intervene is common. Check with your friends -- how many were sent back home when they were so sure it was the right time?
Enter: The Early Labor Plan. By utilizing distraction, we can stay home and labor longer, thus increasing our chances that it will be time to stay because labor is moving along at a more predictable pace. What kinds of things do people put on their ELPs? Here is a list from past clients:
The main idea is, this is a set task or list of activities that you are ready to move through before it is time to go to the hospital.
What's the advantage to having an ELP? Often when those first early labor signs occur, we are ready to jump into the car, or right to comfort measures and plans for birth -- but we aren't there yet. The mind is ready to labor, but the body doesn't need anything special. When we move through the things on our Birth Plan before it is time, we can set a psychological trap for later. You see, if you tried some of your comfort techniques before you really need them, when you do need them, you might feel like you already tried that. This can propel you through your coping measures more quickly, leaving you at a place where you may now consider options you wanted to avoid...not because labor is requiring it, but because our brains are moving to what seems the next logical step.
So, we calm and distract the mind, which gives the body time for labor to build. Don't worry that you might miss your window -- trust your body and its innate wisdom in this normal process to let you know when it needs your attention.
What will you put on your ELP? A favorite walk? Getting your toenails done? Finally beating that video game? Couple your ELP with your body's needs for food, hydration, and rest (remember the point of an ELP isn't to physically exhaust your body!), and soon enough, it WILL be time to move to the hospital and get one step closer to the birth of your baby.
For almost two months, I have been faithfully blogging once a week. I had the opportunity to leave my doula world here in Bakersfield and visit Scottsdale with my kids -- so I took it! I had this experience, which I knew fit right in to what parents face as they create their personal plans for birth.
A family member works at WestWorld of Scottsdale. This is a huge venue where they host horse shows, rodeos, expos, and auctions. We had been invited to the Barrett Jackson Auto Auction -- we watch this on TV every year. With four boys from 3-17, this show did not disappoint!
Our family member showed us the following video, in anticipation of our experience -- she was giddy with excitement as the boys watched with dropped jaws:
After we viewed it a few times, I had some questions for my family member.
"Did you guys know they were going to do that?"
"Did they ask your permission?"
"If they had asked your permission, would you have allowed it?"
Even though she and her whole office couldn't stop watching this video, the answers to all three questions were, "No."
No, they had no idea this was being planned.
No, permission wasn't asked.
No, it would not have been allowed.
There are some scary scenes in this, right? The car drifts past people, past doors, around Mr. Jackson's Bugatti! Things are loud, dangerous-looking, out of the norm for the venue. But the driver has the experience of drifting, and he knows his car. He has learned how the car works, how best to throw a drift, what his car can and can't do. It is obvious he has had a lot of time behind the wheel.
This fits into how we can craft our birth plans.
I recently sat with a couple as they worked to put their birth preferences together. The example they were using was mighty -- like four-pages mighty! Four-pages mighty suggests you list every little thing you might even think of doing or accessing or trying. I suggest a less-is-more approach. Include 6ish of the most important choices you want. Now all the others fall under the umbrella of, we will try them if the time arises and the situation fits, generally without getting specific prior approval, but utilizing something until someone says why we can't. Do you see the parallel now?
So you want to use a peanut ball? Bring it out when it's time -- but you don't need to take up space on your birth plan stating, "Mother will use the peanut ball we brought to optimize baby's position if Mother becomes tired or needs to stay in bed."
Do you get sick or grouchy or faint when you don't eat frequently enough? Instead of writing, "Mother has snacks available and will eat as she feels necessary in order to maintain energy for labor and birth," just pack your food and snack as you need to.
If your goal is to be active in labor, you need not put, "We wish to labor out of the bed, so we will be walking, using the shower, sitting on the ball we brought, and rocking in a chair to achieve this." You can simply show the bed isn't where you want to stay, and get up and get moving.
Ideally, talking to your doctor ahead of time to discover what specific choices your situation warrants provides leverage. What if your doctor says no to everything you want to try? Then look for evidence. For example, in November 2015 the American Society of Anesthesiologists stated, based on evidence, that "Most healthy women could benefit from a light meal in labor." If your provider isn't keen on that, ask about this ASA recommendation -- why does it not apply to you? You can do this for many of your choices -- find the evidence and ask why you don't fit the recommendation. What is often termed as "hospital policy" can be broken down into "provider preference"; ensure you are getting accurate information.
Learn your choices. Understand how your body and your baby work together towards birth. Decide how you want to shape your experience by the options you face. And go for it. If you aren't "allowed" to do something, assess the risks and the reasons, and move forward. Try something else. Keep asking questions. Stay busy and active. This is your machine and you know it best.
Remember that saying: "It's easier to ask for forgiveness than to ask for permission"?
It absolutely applies here.
I was at a birth as a doula in Bakersfield, CA recently where the couple's nurse was wearing a mask. I didn't think anything of it. Soon I realized the parents were worried, because you know, people in masks cannot be trusted (reference, anyone?).
Many hospitals require their employees to get yearly flu shots. Even as a childbirth educator and health worker formerly employed by a hospital-based midwifery clinic in Chico, CA I was meant to get the vaccine -- it was all ready for me in our on-site medical refrigerator. But like many, I chose to decline it.
What does it mean if you decline the flu shot? The Center for Disease Control has this to say about health workers and vaccinations:
"CDC conducts science-based investigations, research, and public health surveillance both nationally and internationally. CDC adopts recommendations that are made by the Advisory Committee for Immunization Practices. These recommendations may be considered by state and other Federal agencies when making or enforcing laws. CDC also has infection control recommendations for health care settings. However, CDC does not issue any requirements or mandates for state agencies, health systems, or health care workers regarding infection control practices, including influenza vaccination or the use of masks. However, some employers require certain immunizations. Hospitals, for example, may require some staff to get the flu vaccine or hepatitis B vaccine or take other precautions such as the use of masks."
(This link also had some very non-helpful links for further information.)
Enter the mask!
When I noticed my clients were looking at their nurse's mask with trepidation, I explained many hospitals require employees who decline the flu vaccination to wear a mask during flu season. The mother looked relieved as she shared, "I just thought she was sick and still working." That's a pretty scary thought when you are about to have a baby!
I then engaged the nurse in our conversation, so she could confirm or clarify what I had said to these parents. She let us know she had a bad reaction to the flu shot once, and ever since, she declines it and opts to wear the mask instead.
I have a good friend, Jessica, who works in a hospital and also chooses, every year, to wear the mask. As a mother who has a vaccine-injured family member, her reason is different: "I always tell people that I feel safer with a mask on my face than a shot in my arm. I feel better protected. The flu is not the only nasty thing that goes around this time of year, and when the CDC only promises 18-30% effectiveness for this year's flu shot, I'm 100% protected with a mask on my face."
The next time you see someone in the health field sporting a mask, don't worry -- they likely aren't sick! They may have just decided the flu vaccination is not a health risk they are willing to take, and this is their way of still serving you safely.
(I know Jessica would appreciate if I linked to the website for Vaxxed: From Cover-up to Catastrophe. Her mask stickers actually mention the movie, but the text wasn't coming out clearly in the picture, so I changed the words to better fit this post.)
When living in Chico, California, and starting as a doula, I did not enter this work with a professionally-created business plan clutched in-hand – I walked in with my heart open and extended, ready to help families. The focus on business in the doula world has been huge in the last few years, and I absolutely see the value in that. When I started as a doula, there simply were not resources past the doula trainings we took. I did as many others did – made things up as I went along. With freedom and (eventually) experience, I made changes as needed to better fit how I wanted to do business. I have known all along that I do things differently than many other doulas, and I am perfectly content in that. In order for me to stay sane, happy, and sustainable as a doula, my business beliefs and practices have to match me. Take, for example, payment.
It is the norm for doulas to be paid-in-full before a baby is born – often by 36 weeks. The agreement generally is, if you have not paid your doula before your birth, she does not consider herself on call for you. I deviated from this years ago after seeing an uncomfortable situation with a doula friend and her client.
Anne was called to labor with a client at home. The client had not yet paid the second half of Anne’s fee, but Anne made the choice to attend her client. After a night spent working through contractions, labor stopped. Anne left to wait for her client to share when labor began again. But Anne’s client never called, and soon Anne learned the baby had been born. Expecting to be paid, Anne contacted her client to make arrangements. The client, though, expected that since she didn’t have direct doula support for the birth, nothing was owed. For weeks and months I saw this play out, and I felt bad for Anne. The amount of time and energy she put into trying to collect payment was painful to watch. I understood Anne’s side of things, and yet I could imagine a situation where her client felt good about birthing without a doula.
Anne never was paid.
I have since moved from Chico to serve the areas of Visalia and Bakersfield, yet my belief hasn’t changed: my true heart of this birth business lies in wanting families to have what is right for them – even if that means they change their minds about me. I cannot stress this enough! Thoughts come to me: what if a family finds that fee-remainder would be more important to them than doula support? What if I miss a birth? What if they are laboring confidently and a doula’s presence doesn’t fit the flow of their birth? What if a planned cesarean birth is needed and they feel well-enough supported? I wanted my clients to have an “out,” to be free not to call me, without worry of penalty.
My contract expectations are as follows:
There it is – all in place should a family find it useful.
This structure is worrisome to many doulas I have shared it with. What about being on-call and then suddenly having your time wasted by not attending the birth? Unless I block my calendar out for specific dates (and as my husband is a teacher, I block out some time in the summer), I am on-call a lot. When weighing this as an option for families (against my inconvenience), I want families to win.
Ultimately this has been more of a non-issue: I am getting close to 200 births as a solo doula, and I changed my contract to reflect this option around birth 30; in all of that time, I have never had a family NOT call me, and I have never had a family NOT pay me. So why keep it in my contract at all, if it isn’t going to be used? Because I believe birth is a time when your choices shape your outcome – and who is on your birth team should always be one of your choices.
I had a client once whose doctor openly laughed when she said she wanted to delay her baby’s umbilical cord clamping. Her doctor claimed there was no benefit – which (he assured her) is why they cut cords so quickly. He went on to share the “risks” as well: the baby would get jaundice, the baby could get a dangerous “backflow” of blood, and my client’s chances of bleeding too much after birth were increased. My client still chose to delay cord clamping (except the delay wasn’t as long as she had wished), and mother and baby were healthy and happy, with no complications.
The American College of Obstetricians and Gynecologists released a committee bulletin entitled “Delayed Umbilical Cord Clamping After Birth,” and it replaces their past 2012 opinion (which I cannot even find to link to, as I keep getting 404 error messages), which was not terribly positive or supportive. What a benefit to have current recommendations to share with our ACOG-connected providers! The Institute of Medicine says it takes an average of 17 years for professionals to change the way they practice medicine based on new evidence – so it is up to parents to advocate for best-care practices, and understanding current ACOG recommendations is a great place to start.
For some really great information check out this Lamaze "Science and Sensibility" post where Dr. Mark Sloane shares the evidence in favor of delayed cord clamping.
Another favorite I have shared in my classes for years is this piece which claims delayed cord clamping is a baby's frst stem cell transplant.
And of course, ACOG's recommendations are the base of this post an infographic -- families don't forget to print out the pdf to share with your provider.
♥ four young boys and a boy dog (offspring)