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.
Marivette is another Bakersfield area local, and this is also her third time participating in the 31 Days project. She holds the record for most repins in her first post, Using the Rebozo in Labor. I had the honor of joining her at a very long homebirth recently, and with the casual nature of this labor, family, and birth team, in the long stretches between serious midwife-needed events, I saw Marivette's doula side shine though. Ever appreciative for all the support a woman gets in labor (and let's be honest, it made my job easier), I saw Marivette's knowledge and understanding come though her voice, her eyes, her touch. I know she will be an incredible midwife, and the families she will serve will be in great hands.
I have been a doula for 18 years. I began after the birth of my third child who was born at home with a direct-entry midwife. My midwife asked me if I would help her at births, and that launched me into being a home birth doula for seven years. She eventually moved away, and at that time, it was too far for me to travel to be a doula for her clients. I decided to start attending births at hospitals, and I have been an in-hospital doula for 11 years now.
When I was a doula at home births, I never saw myself in the position of midwife. I think at that time in my life, I wasn’t ready for that kind of responsibility. My children were all very young, and I wasn’t yet done having children. I was a lot younger, and I felt I wasn’t quite qualified and didn’t have enough experience to be in that role. So, I’d occasionally tell the midwife with whom I worked, that I didn’t want to be a midwife. I also thought that midwifery was not for me. After all, I had been pregnant while a senior in high school, barely graduated (attended a California’s continuation program to finish high school) and I had five children by the time I was 29 years old. By the time I was 38, I had eight children. Life was busy enough with homeschooling, church, helping my husband with his business, and being a doula. I couldn’t possibly add anything else to my over-flowing plate.
Well…that all changed in 2014. I noticed a trend in homebirths not only in the nation, but in my own community. I noticed no midwifery care was being provided to Spanish speaking women in my community. While English speaking women at least had the option of receiving midwifery care from a midwife who spoke their language if they so desired, Spanish speaking women in my county do not even have that option. “Someone should do something about this!” I thought. I still didn’t think that person would or could be me.
I became friends with a doula in a nearby city. She also has a large family, AND she was studying to be a midwife. I was excited for her! A doula-turned-midwife was a great journey. As the months and years of our friendship developed and grew, she eventually finished midwifery college, passed the NARM exam, and became a licensed midwife. During this time, I began being moved to pursue midwifery. I think it was always in me to become a midwife, but I just couldn’t imagine how I would pursue a midwifery degree. Watching my friend inspired me, so I began asking her questions about midwifery school.
My friend patiently answered all my questions, provided me with links, and fully encouraged me to go this route. I talked to my husband, I prayed about it, and I -- finally -- knew this was the next step for my life.
After looking at different schools, I chose Midwives College of Utah (MCU). MCU offers continuing education classes and these classes are a non-committal fashion to figure out if a distance education platform works for a person. After one semester of continuing ed classes, and getting a feel for how MCU operates, I knew, for sure, this was the school for me. I began the process of enrolling, and I was accepted into the Associates of Science in Midwifery at Midwives College of Utah in August, 2015. It will take me three years to complete the academic portion of the associate’s degree, and possibly another year to complete the clinical portion, totaling four years before taking the NARM exam.
Changing careers at the age of 45 has been an exciting and stressful adventure. My whole life, and how I operate, changed drastically. I went from having plenty of time to do all the things household, to doing school work 6-8 hours per day, including the weekends. I had to adjust my way of thinking, accept that going to school is the same as having a full-time job. When deciding to take vacations or weekend trips, or even day trips, I look at my calendar. I may have to do extra school work to make up for days I won’t be able to get any work done. I may have to take some school work with me, and get some studying done while on vacation. I have had to adjust everything around my education, and it has been difficult to make that transition.
Everything, right now in my life, is all planned around my schooling. In case any of you might by thinking, “Well there are summer breaks.” No, actually, there aren’t any summer breaks. MCU operates on a trimester schedule. That means, school runs all year long. We have four – fifteen week semesters: fall trimester, winter trimester, spring trimester, and summer trimester. Between semesters, we get a two-week break. That’s it, folks! So, no summer breaks! Now, if I plan it just right, I can finish up about 3 weeks early, and have about a 5-week break, but that means doubling up on assignments to get done early. It’s doable, but not an easy task!
Currently, I am in the assist phase and working with a preceptor (a licensed midwife who has been approved by MCU to be my supervising midwife). Being in an apprenticeship is such a blessing, but such a huge change for me! I have been accustomed to being in the doula role (education, information, and labor support – which means, never any medical advice is given and no medical procedures are ever done!). Being in the midwife apprentice position is completely different. I get to check blood pressure, pulse, and feel the abdomen for the baby’s position (Leopold’s maneuvers). These are things which are out of the scope of practice for doulas, but within the scope of practice for midwife’s apprentice while under the supervision of a licensed midwife. It’s amazing and exhilarating to be in this new role!
Another big change, for me, is that I now call meetings with my preceptor’s clients “prenatal” appointments. As a doula, I never felt comfortable calling meetings with clients a “prenatal,” because that, to me, is a term used to describe an obstetricians or midwife’s appointment to receive prenatal care. But, now, I am in the midwife’s apprentice role, and can call these "prenatal" meetings.
Going from doula to midwife is completely polar opposite. Doulas provide one to three meetings before birth, provide education, information, and emotional support, provide labor support, some breastfeeding support, and one visit after the baby is born. Doula support is invaluable! Doulas do not, however, provide any medical services, whatsoever.
Midwives provide one prenatal visit once per month from 4 weeks – 28 weeks of pregnancy, one prenatal visit every 2 weeks from 28 weeks – 36 weeks of pregnancy, and one prenatal visit from 36 weeks – 40 weeks and beyond if needed. That’s a total of approximately 15 prenatal visits. These visits include blood pressure, pulse, weight, and fundal measurements. They include lots of information on pregnancy health, nutrition, exercise, and things to expect. They make sure mom and baby are well, and that there are no medical issues. If there are issues, they refer them to an OB. Each prenatal visit typically lasts an hour, sometimes more…Postpartum, they provide approximately 3-4 visits…
So, for me, going from the doula role, to the midwife assistant role, has been a huge transition. Being part of the care a woman is receiving during her entire pregnancy is a completely different role from the doula role. I am in transition. As we know, transition is a hard place to be -- and I am eager to make the changes to get to my dream of becoming a midwife.
Marivette Torres is the founder/owner of Tender Doula Hands, a rebozo trained instructor and distributor. She is a CBI certified birth doula with 19 years experience serving the Bakersfield, California area. She has eight children ranging in ages from 26 to 8 years old. Her first child was born via surgery at a community hospital due to breech presentation. Her subsequent seven children were all VBAC births, two of which were born at a hospital birth center and five were born at home attended by a midwife.
She is currently undertaking her dream of pursuing a midwifery career. You may visit her website and
Facebook page. She also has a page dedicated to specific rebozo class information.
I heard a doctor say once, when presenting a pivotal intervention to the family I was working with, "If you were my wife, this is what I would do." It truly does offer the feeling: "He really cares about me." This is actually a fallacy -- faulty emotional appeal. It isn't based on science, or evidence, or the unique needs of mother and baby. It is simply an opinion said with feeling, and it can be swaying. Maddie McMahon hits the nail on the head here, and she offers sage wisdom to those of us who work with families -- families who may be vulnerable to the words we say and feel with emotion, that may not exactly be the truth.
These are the kinds of things I hear parents saying quite a bit, and they always remind me that being kind is just not enough. Meaning well is just not enough. Smiling and speaking gently is just. not. enough.
There is a lot of talk in health care about compassion. And so there should be. It should pretty much be a core quality of anyone working in a caring role. Compassion means having a deep understanding and sympathy for another’s suffering. It also means wanting to do something to fix that suffering and take it away.
The problem is, compassion on its own can be a problem. If we believe we can make this all better, if we believe we know better, if we can’t bear to see present or potential future suffering, if even the idea of risk is frightening, then compassion can be dangerous.
Compassion needs to be tempered and balanced with empathy. The ability to enter into another person’s feelings, to see the world through someone else’s eyes. It is this ability that allows us not to get caught up in our own emotions and not get swayed by our own assumptions as to what might be right of wrong for this person. It is empathy which allows us to step outside of ourselves, just a little, and make space to really listen – and more than listen, understand WHY someone might feel the way they do.
So my plea to you wonderful, compassionate practitioners out there, whether you are doctors or midwives or nurses or lay supporters like doulas: Please try not to coerce with your kindness. Is this mother doing as she’s told because you’re so kind and she doesn’t want to upset you, or is she making a fully informed decision? Are you laying YOUR stuff on her or are you truly holding the space while she looks at the benefits and risks of all her options then follows her heart? True kindness and care means trusting that those we care for can make safe, appropriate decisions for themselves, even if we disagree with them.
My New Year resolution this year is to pour a cup of Alongsideyou Tea and strive to listen harder and longer and deeper, whenever I can to everyone I meet and give my empathy muscles a workout.
Maddie has been a doula since 2003. She is a Doula UK Mentor and runs Developing Doulas, a Doula UK approved doula preparation course. She is a founder-trustee of Cambridge Breastfeeding Alliance and also a Breastfeeding Counsellor with the ABM. She recently achieved her childhood dream of being a published author with the publication of Why Doulas Matter in 2015.
She enjoys blogging on her site for parents and birthworkers The Birth Hub.
Mum to boy and girl teens and stepmum to one all-grow-up boy, she lives and works in Cambridge.
Day 2 brings us to a clarifying list about doulas! I will admit, just yesterday a friend from church said I was a midwife, and I had to explain the differences between the two professions.I had a great conversation with Becky, and I learned she has great taste in books and music! Fabulous to know there are doulas all around the world who believe in the importance of helping women achieve safe and satisfying births, despite the unique, local obstacles we face.
Yeah, yeah, we all know what a Doula is but there’s little information out there on what a Doula isn’t. I’m going to change that!
1. They are all Hippies who only attend natural births. Natural Birth? Let me scratch that one right away! Birth is natural. The End. If you are a human who births a human baby, that my friend, is a NATURAL BIRTH! Taadaa. We can categorise birth into vaginal, assisted, surgical ect but a human birthing a human is a natural event. Doulas attend all kinds of birth. Whether you plan on birthing at home in the water or in theatre with a surgeon, you can be assured there is a doula out there to support you and your family on the day you meet your little baby for the first time. Hippies? Yes there are some Hippie Doulas and I can hook you up with some if that’s what you need. I, however, shop at Tesco, dye my hair, wear business attire 99% of the time and occasionally feed my kids Mc Donalds!
2. They protect women from their care providers. Really, if you are attending a birth place where you feel you need protecting from your care providers then we’ve got much bigger fish to fry than simply hiring a doula. I’m very glad to publicly state that all of my clients have had a great relationship with their care providers and had amazing support on the day. I don’t believe women need protecting from care providers. I believe care providers are people who made a profession out of caring for people. I have had clients change their birth place, obstetrician or move to a more suitable model of care to suit their preferences for birth. We call it stacking the odds in your favour. I trust my clients to choose the best care providers for them, if they are happy with the team they’ve chosen then I am completely behind them and will support them 100% of the way.
3. Doulas are just like Midwives. Midwives are health care professionals. They have an impressive range of skills. Doulas also have an impressive range of skills but they are on very a different spectrum. The only similarities between doulas and midwives are that we both offer emotional and physical support for birth. Doulas do not preform any clinical tasks. We do not advise clients. We do not advocate for the woman. We are present, we offer continuity of care, we offer information, education, physical and emotional support. Support. We have a relationship with our clients that unfortunately, most midwives don’t have the opportunity to have. No, we don’t catch the baby but we will be right there cheering you on if you want to!
4. Doulas advocate for you. You are the advocate, your partner is the advocate, your midwife is the advocate. Your doula is an ever present support person. We do not advocate. See point 2. We trust you to have chosen the best possible set of circumstances for the birth you want so we trust that there is no advocating to be done on your behalf. This is YOUR birth. It isn’t ours. We don’t ever want you to feel pressured or swayed to have or continue on the path of one particular type of birth. This is where “unbiased support” comes into play. You can change your mind. That’s perfect. If we’ve done our job right at our antenatal visits, you and your partner will be ready and able to do all of the advocating on the day. We may offer gentle reminders of conversations and wishes we’ve spoken about prior to the birth but ultimately, our job is to help you find your voice and feel strong and empowered to use it!
5. Doulas will work for free range eggs! Seriously, there is a misconception out there that doulas will work for little or nothing…..or eggs. I am a person just like you. I’ve got a mortgage, a car to run and kids to feed. I don’t work for eggs and frankly, I wonder about trusting a person willing to work for eggs to support you on the most important day of your life to date! Yes, hiring a doula in an investment. You are paying for your doula to be within range, without alcohol, have childcare arranged and be willing to drop everything at the ring of a phone to come at be with you during your labour. All of that for up to 5 weeks, 24 hours/ 7 days a week. That’s not counting the hours spent on the phone, texting, emailing and having access to her wealth of knowledge for your entire pregnancy and post partum period until you part. So yeah. Eggs?
6. Doulas replace the partner. One of the most memorable births I attended was jamming out to Macklemore with the Dad while the Mum was “surge twerking” to the beat. It was FUN. Serious FUN! After the birth the Dad turned to me and said “Thank you so much for being here, I was dying to pee until you came and they don’t warn you how hot these wards are. You need to drink water, then you have to pee.” Doesn’t seem like a big deal but being able to run to the bathroom while your Love is in the throes of labour is a huge deal to a partner who maybe needed to pee, maybe not, maybe just needed a breather from how completely overwhelming birth can be when you’re experiencing it for the first time. I love attending births with a life partner present. The partners also love that they can relax, breathe and off load a tonne of the pressure. It’s win win to have us both there.
This guest birth story is by a friend who, after 5 boys, had her baby girl. Nicolle was instrumental in helping me find my midwife when I moved to Bakersfield pregnant -- this was her hometown. I knew Linda Cowley was right for me when, at our interview, my dog sat on her feet! I owe Nicolle a debt of gratitude for her recommendation, and in an abuncance of good karma points, she found a midwife just as excellent to help her with Keira's birth. Enjoy the story and pictures!
On March 29th, 2014, my blue streak ended. I had a daughter. She was a total and utter surprise, starting from her pregnancy. I found I was pregnant after losing a pregnancy early in the first trimester. I assumed I would be having another boy. I don't think I allowed myself to even entertain the thought of having a girl, but shortly after finding out I was pregnant I bought a tiny pink nightgown, keeping the tags on, because surely I would be re-gifting.
My pregnancy progressed normally. I was taken care of by a great midwife. I can say in my life I have had the privilege of knowing some very amazing midwives. Randi was no exception. I called her for a consult, she came to my house, and I knew in my gut she was the one. I had interviewed several homebirth midwives at this point, but had not yet pulled the trigger After my initial consult, I hired her on the spot. I knew she was the perfect fit to help me and guide my baby earthside. She was competent, confident, and smart. I felt immediately comfortable, and it felt I had known her a million years. Our appointments were like a visit from an old friend. Lots of laughs and love.
Towards the end, baby decided head down was for losers. This baby decided breech was the way to be. I immediately called Randi, who came out the next morning and confirmed the lump I felt under my ribs was exactly what I thought it was, a head. No panicking, no freaking out was done by her, she was cool as cucumber. My mother, a seasoned midwife said inside she probably thinking, "oh for the love of Pete, this great big baby needs to turn head down immediately or I will have to be carried out of here on stretcher." We did some exercises, threatened the baby with a spanking(haha) and that silly baby turned head down. And then I stayed pregnant for another few weeks, as my babies like to do.
41 weeks came and went. Xander, our oldest, was to be confirmed on March 30th. March 28 came and bit of urgency was felt by me. I did NOT want to be in labor the day of his confirmation. My mom and Cheryl, my ever present birth partner, made the 5 hour drive up north. But, alas, no labor came.
I woke up at 12:45 AM, March 29th, with my water breaking in bed. I shook Jacob awake and told him my water broke. He didn't really wake up, but moved over so he wasn't laying in amniotic fluid. I heaved my very large self out of bed and had a contraction that brought me to my knees. I had to have Jacob get out of bed to wake my mom and Cheryl, and call the midwife. I was having back to back contractions and couldn't do anything but stay kneeling over my bed, preparing for the next contraction.
Things moved quickly from that point on. Randi made it, and my friend Danielle was there as well. Cheryl was taking pictures and I was getting close. I have always labored a long time, but this time it was different. I was going fast. Jacob and I seemed to be completely in sync with each other, and I didn't really have to even articulate what I needed, he just knew. Between he, my mom, and Cheryl, I was very well attended to, and I had a lot of help to support me through my intense contractions.
My contractions were on top of each other, and very intense. I thought maybe the bathtub would help, but I didn't care for it, at all. I had a really hard contraction when I was getting out of the bath, and I told Jacob I didn't think I could handle another like it. I started to get a little a weepy, and my legs started to shake, a sure sign of transition for me.
I was not feeling the urge to push, although I was fully dilated. Baby was high and floating. Randi said I could push if I wanted to, and I didn't want to, but it was going to be the only way to get this over with. I pushed, and the amniotic sac bulged out like a tidal wave. My bag of water burst explosively, shooting up over the chux sheet Randi was shielding herself and Jacob. Keira's head quickly followed, and with one more push came her body. I heard Jacob say "I think it's a girl!" and the whole room just came alive. I laughed, and then I cried tears of joy. I could not believe I had a daughter. I kept saying over and over I can't believe I have a daughter. She was perfect. Just perfect. She breathed and cried, and was trying to nurse while she was still connected to me. I was on cloud 9!
I wish I had to words to describe how the air felt in the room. I wish I was not limited by language so I could fully explain the joy, the peace, and the euphoria I was feeling. That feeling, that is birth. That is why it happens in a sacred place, the place where that child was created, a living token of the love between Jacob and myself, who are given the privilege to create life.
My child was welcomed into the world surrounded by those that loved her the most. The first hands to touch my daughter were the hands of her grandmother, who lifted her into my arms, the arms of the woman who would be her champion until the end of time. My world was complete.
Keira Kristina was born on March 29th, 2014 at 3:16 AM. My fastest, easiest delivery. It was everything I wanted it to be, and I wasn't in labor for Xander's confirmation. She was gracious and came the day before. My mom made it, Cheryl made it, and she took the most beautiful pictures. I will treasure them always. A truer friend there never was. I am pretty sure she'd drive the Bronco in a slow speed chase if I needed her to. Randi was perfect, just perfect. She slipped out of the room after I delivered the placenta and was tucked into bed, Facetiming my sister. She came back in with a plate of snacks, and yummy tea for me, and had thrown in a load of laundry for us. I love her so, and I forever am in debt to her goodness to me.
Two years later, and I am still reduced to tears of joy when I think about my girl's entrance into the world. She is just what this family needed!
Just a few shout-outs to some great professionals:
Linda Cowley, LM, CPM, serving the Bakersfield Area
Randi Payton, LM, CPM, serving the Greater Sacramento Area
Cheryl Lopez Photography, serving the Bakersfield Area
Before working as a doula in Bakersfield, Visalia, Hanford, and the lower Central Valley, I was in Chico, CA -- up north. This mother was a client of mine, and here she is shown having her second baby at home, after a very medicalized first birth due to her baby's health issues. This time around she labored all night, with erratic but strong contractions. When she finally realized they needed the midwife, it was just in the nick of time! The joy and ecstasy she experienced by this fast, healing birth shows in her body language, and of course her face! For this woman, being left undisturbed to labor was a huge part in the emotions and feelings that helped her have an ecstatic experience. It is a day she will always remember and have pride in -- and no matter how a woman's birth experience goes, with support from her team and knowledge of her choices, she can also be left with these good feelings.
I first met Teri at a doula gathering where I shared my experience creating a group doula practice. The energy in that room was invigorating, and I wasn't surprised to later learn these doulas had created their own successful group. Teri and I had a thoughtful exchange about how this summit left her feeling, and I believe she brings excellent balance to these trickier topics that factor into birth work.
Last month, I had to the good fortune to live close enough to Berkeley, CA to know about and attend the first annual Birthkeeper Summit. To be honest, I wasn't sure why I was going other than to be in the same room as Michel Odent, Robin Lin, Nan Koehler, Loretta Ross and a number of other birth visionaries and human right activists, and to hear their wisdom firsthand. The academic in me has a hard time resisting conferences, and so it was obvious I would go. The doula in me, whose goal it is to help moms have whatever birth they feel is the right birth for them -- a goal that never comes attached to other agendas -- was a little hesitant. There were going to be some strong personalities and a whole lot of agenda-driven discussion. My stress level rose just thinking about it. Yet I knew if I didn't go, I'd be missing something significant. I braced myself for the potential of being overwhelmed by birth activist energy, shelled out my $100 for the entry fee, and took four days off-call from my very busy practice. (Many thanks to my doula team for making that latter event possible.)
The Summit did not disappoint in regard to being overwhelming and was more than a little transformative for me personally. It brought together a diverse group of birth workers who advocate for evidenced-based birth practices and access to safe and supportive care, and others who actively pursue reproductive justice and familial rights. It offered several panel discussions with experts in their respective fields, an eclectic assortment of more than 40 classes and lectures on topics ranging from social activism to spiritual healing, several movies and rare documentaries, and many opportunities to network and socialize. In short, the summit participant had ample opportunities to get cerebral, ethereal, and/or real. I both entered and came away with the sense that there was perhaps a little too much going on and not enough time to experience more than a quarter of it. In addition to the obstacle of not enough time, the Summit encountered the challenges of meeting the needs of such a diverse group, not all of whom came prepared to engage in constructive ways with one another. I had expected a symbiosis, that all of us would be coming together from our different backgrounds to find each other's strengths and work together. Instead, there were awkward and uncomfortable moments when I felt we were called out and separated by our identities, affinities, age, experience, and even the color of our skin. Kathi Valeii at the Birth Anarchy wrote about that part of the conference already, so I can leave it there, sufficing to say in retrospect that it forced me to think a little harder about my own identity, and, difficult as it is, more self-understanding is always a good thing.
On that note, let me begin my top 10 takeaways from the Birthkeeper Summit 2015:
1. As birthworkers we must acknowledge our own biases and limitations. We must also acknowledge that no one doula can be the right doula for every client. If a woman of color/queer identifying/transgendered/teen parent needs a doula of color/LGBTQ/teen to feel understood and supported, that is her prerogative. If you're a middle-class, white doula, it's not personal, so don't take it personally. Side note: If you identify in one of those former categories, the birthworker community and birthing families need more of you.
2. We all have birth stories which are valid and worthy of being heard. None is more or less significant than the other. Each individual story has something from which we can all learn.
3. One can and should be open to hearing and trying to understand the experiences of others, but this willingness is a lost opportunity when those with wisdom refuse to share it. If all you know is your own experience, your universe will remain hopelessly small. Engage and seek knowledge. Side note: Be mindful of respectful discourse. Don't expect that it's anyone's obligation to teach you.
4. Be kind to the students. We are all children of this earth and as such we all ask dumb questions sometimes. Side note: The teacher and parent in me feels obligated to say here that there are no dumb questions.
5. Loretta Ross said some brilliant words that resonated with me: First, don't be allies, be a "co-conspirators." Second, invite people into dialog, especially those with whom you don't agree. Call each other "in," don't call each other out.
6. Every community of women deserves a red tent. Apologies for the cultural appropriation, but it's a useful adaption. In this case, women (all people actually) deserve a place to come together in safe harmony to share their stories and repair their spirits. In the birth community, we sometimes call that space a red tent. The refuge of the red tent at the Summit was lovely and restorative. Many thanks to whomever put that together.
7. Paraphrasing Michel Odent speaking on the research done on initial stress responses and their effects on newborns who experience immediate separation from mother at birth: "It's taken 100 years for the medical community to figure out that a newborn needs its mother." We've still a ways to go on reclaiming that "golden hour" of bonding time for healthy newborns. Side note: He's also got intriguing data collection on what happens to babies who aren't given a trial of labor. If you don't know who Dr. Odent is, look him up.
8. As a birthworker, who immersed myself in the culture of evidence-based care for an extended weekend, coming back to the real world was painfully hard. My first week back involved supporting a mom who was fighting against a 39-week routine induction and whose care provider had no interest in hearing about her evidence-based arguments. On the plus side, ACOG's letter for the BKS organizers announced that they were considering "collaborative team-based care that includes the mother as a member of the team and a key decision maker." One can hope that in my life time this becomes the new standard practice.
9. Listening to Katsi Cook and Isa Gucciardi, I became envious of cultures that retain a process of initiation. Modern American culture has forgotten how to initiate people into parenthood (and adulthood for that matter). A baby shower, grocery store encounters with strangers, and well-meaning but often fear-filled birth stories hardly fulfill that role. I'm not sure the appropriation of blessingways do the job better, but they are a step in that direction. Side note: Take a minute to celebrate your mother, because chances are good she had to figure that role out all on her own (see above about being kind to students...).
10. Lastly, to the doulas out there: Take a minute to honor yourselves. You do hard work, often without a lot of compensation other than the satisfaction of knowing you made a difference to every family you worked with.
Teri Nava-Anderson, PhD, CD of Harmony Doula is a birth doula, doula trainer, childbirth instructor, La Leche League leader, mother, and historian. She is passionate about encouraging doulas to advance their skill sets and helping moms advocate for their best care. She is the co-founder and lead mentor at the Modesto Doula Group and a board member at the Mt. Diablo Doula Community. Teri is an advocate for the creation of doula group practices for the health and well-being of both doulas and birthing families and advises and mentors doulas seeking to move from private to group practice.
Amber is a doula near and dear to my heart. She came to the first DONA doula training we had in Chico, and we fast became friends. Her heart truly lies in serving women during the birthing year. It was a natural bridge to apply and be accepted into Chico State's Nursing Program. Here Amber likens the feelings and changes she has experienced during her first semester of nursing school to those pregnant and birthing moms pass through -- pregnancy and birth -- truly the metaphor for the transitions we face in life.
Doula work made me fall in love with birthing women. The sacredness and magic that surrounds them as they work so hard to bring their babies into the world is intoxicating to be around. After working as a doula for the past seven years, I made the leap to enroll in nursing school, with the goal of working as a labor and delivery nurse for a while, then becoming a midwife.
I had no idea what nursing school would be like, only that it was extremely hard to get in to. I am now in the last week of my first semester, with four more semesters to go, and honestly, I can't believe I made it through my first semester. Nursing school is hard, people told me. I had no idea just how hard it really was. But now I truly do.
As a doula, I have been right there when women who were so elated to be having a baby before labor began, suddenly expressed that they just couldn't go on. And I was there when, indeed, they did go on to birth their baby, despite all their doubts. They made it through the other side of labor and birth. It is this inner journey and challenge that I have witnessed so many times that has helped me get through this first semester.
I have often thought of the strength I witnessed as a doula, to get me through the tough days of nursing school. As I held on for dear life, going through the rollercoaster of emotions, joys, and challenges of becoming a student nurse, I drew some similarities between nursing school and becoming a mom.
Stage 1: Wow! I'm pregnant! (Or I can't believe I got into nursing school!)
When a mom finds out she pregnant, some great emotion is sure to overtake her, whether it be elation, surprise, sadness, or anxiety. At first she might not believe it's really happening, but eventually the reality settles in.
When I found out I got into nursing school, I cried. Getting into nursing school in California is no small feat. I was one of forty students to be accepted (out of 174 applicants!) and I was in total shock that I actually got in. I started dreaming and planning, and getting ready for the semester to start.
Stage 2: Wait, I didn't know I was signing up for this!
After the initial shock, joy, or acceptance settles in, the gravity of the life altering event which is motherhood is realized. Hopefully she won't get too overwhelmed by all of the choices, options, and decisions she needs to make as she prepares to go into labor.
My pride that I got accepted into nursing school was quickly forgotten as I settled in as a student. Beginning the first day, we had reading assignments and a presentation due. It became clear that yes, I had accomplished a huge hurdle by simply getting in, but the hardest part was yet to come.
Stage 3: I can not possibly go on any longer
This is the point at which moms who were planning a drug-free birth use all of their inner strength to just make it through the next breath. Thinking too far into the future leads to desperation and fear that it will never get better.
There were many a days this first semester when I just wanted to curl up into a ball and not deal with the stress, and the huge workload, and the pressure to not mess up during clinical. Some mornings I was in tears as I got ready for school, and I had to take a deep breath and not think too much about what was due the next week, and how I had to wake up at 4:30 in the morning the next day.
Stage 4: I did it!
Whatever her doubts, whatever her fears, she did it. Even if things didn't follow her carefully written birth plan, she accomplished what she set out to do: have a baby. The journey there was important, and she went through many travails to get there, but the fact that she herself grew a baby and birthed it is something no one can take away from her. She feels part of something bigger than herself -- a connection with all other mothers that have come before her and given birth.
Despite my tears, and my anxiety, and my mistakes, I have made it through my first semester. I have one more week left in my first semester of nursing school, and I have so much more respect now for nurses. My aunt who's a nurse recently told me "this will be the hardest two years of your life" and I don't doubt that she's right! But another nurse family friend told me "if you can make it through the first semester, you will make it the whole way."
Stage 5: Be gentle with yourself
New moms might feel lots of different emotions after the birth is all said and done. Maybe they are disappointed with how they acted, maybe they wish they could go back and do things differently. But then (hopefully) they look down at that sweet new baby, take a breath, and realize no matter how they did it, they accomplished a major feat. They deserve to be pampered, and they should know how strong and courageous they really are.
I've made mistakes this first semester that I desperately wish I could take back. But you know what? When I stopped hounding myself, and looked around at my classmates, I realized we're all making mistakes. That's the beauty of being a student. That's how we learn. I know I did my best.
Nursing school is indeed so much harder than I ever imagined it to be. I simply had no idea what to expect. I prepared for it, printed and read all my syllabi before class, had all my supplies in order, but there was simply no way to make this semester easier. There was no way to get around the stress and the emotions, I simply had to go through it.
Just as a mom must go through her labor, whatever twists and turns it takes her on, she will have that baby in her arms. And I will graduate with my Bachelor's of Science in Nursing and become an RN. I just know I will.
Amber is a Birth and Postpartum Doula, certified though DONA. She is also a Placenta Encapsulation Specialist. She has participated in a volunteer doula program, helped start a local doula group, and Was trained to assist midwives at the Farm with Ina May. Putting these skills to work, she has assisted a few different homebirth midwives. Nursing school was her next challenge, with the future hopes of working as a midwife. She is an asset to families with her caring, quiet, compassionate ways, and this will carry over to all she does in the birth world. She is on hiatus from births right now, but continues to offer placenta services.
There is a lot of talk about what your ecological footprint is -- meaning, what impact do you have, because of your lifestyle, on the earth and its resources? Being in the world of moms and babies as a doula and an educator, I have seen a different footprint we can leave, a Birth Footprint.
Basically, your birth footprint is a combination of your personal experiences, beliefs, biases, and philosophies that could be projected onto other women and families -- instead of the pressure you put on the earth, it's the pressure you put on others.
Here are a couple examples of exerting your birth footprint (and they happen to be mine!):
Giving clients opinions instead of actual facts. We don't try to do this intentionally, but rather, we give anecdata from what we have seen or experienced, versus evidence-based information that comes from reputable sources such as Cochrane Collaboration.
With my second pregnancy, on my due date, my midwife asked if I would like my membranes stripped. I was tired of being pregnant (who isn't by 40 weeks, huh?) and I willingly agreed. Nothing happened, not one thing -- I was pregnant for another week. In my mind I equated membrane-stripping with a low-risk intervention, not inclined to do much.
Back when I was certifying I had a client who was offered a membrane-stripping by her practitioner. She agreed, and immediately began contracting every 9 minutes. This was the start of hours of uncomfortable, non-progressing labor. She went to the hospital after 12 hours with contractions still no closer together or longer in length. She begged her practitioner to allow her to stay the night and he agreed. The next morning, 24 hours after the membrane-stripping with still no change in contraction pattern or cervical dilation, her practitioner broke her water, offered her an epidural, and began induction procedures. This mama hadn't slept all night, her epidural wore off three different times, and by six pm, she was offered a cesarean birth -- exhausted, she agreed.
I had no part in her decision, we had not discussed this topic beforehand; but if she had asked me about membrane-stripping, I might have said, "It's no big deal, it doesn't do anything anyway." My answer would not have been true! While Cochrane states, "to avoid one formal induction of labour, sweeping of membranes must be performed in eight women," it goes on to mention "sweeping can cause discomfort during the procedure, bleeding, and irregular contractions" -- all of which my client experienced. Her contractions didn't change her cervix, but they did wear her down, diminish her spirit, and factor into the making of decisions she previously wanted to avoid.
Letting personal biases interfere. As we work with different practitioners in the birth world, we get good ideas about who we like, and who we would like to avoid. A woman sought out my doula services, and I was thrilled when she shared her midwives were my midwives. An assumption came from this: I knew these women well, I valued their skills and their style, and I had two of my babies with them in amazing-to-me births -- I guessed my client felt the same. But guess what? I was wrong. My client was having doubts about her connection to the midwives, and while she tried to process her own feelings, I was trying to talk these women up, in the hopes that my client would feel better about her choice to birth with them.
What I didn't realize was, this chipped away at my ability to be the non-biased sounding board my client deserved. My attempts to smooth the rough feelings my client had were actually setting us up for division, as I was supposed to be on the mom's side, and it seemed like I was on the midwives' side. Before things got to an uncomfortable point, I saw my job wasn't to fix the situation. Instead, I offered communication strategies my client could implement, including role-playing with her so she could practice conversations before her appointments. She had a memorable birth with just the right midwife, and I had a memorable lesson in my client's needs and feelings coming first.
Questions to ask yourself if you are a birth-worker:
1-Do I bring up my own experiences of birth and share them readily with my students or clients? No doubt having babies is exciting and life-changing. We do have a need to share our stories, this is human nature. I have joked that every woman has to share her birth story 78.4 times before she can move past it to help another woman. If she tries to move into birth work before she is ready, her expectations can be either to help women avoid an experience like she had (if it was less-than-satisfying), or to share a formula that other women should follow to have an experience identical to the one she had. This is the client's experience, let it be shaped by her education, desires, personal beliefs, and choices, and she will come out with an incredible story of her own to share.
2-Do I encourage her to find her own way? Another trap if you already have children is, when your client is presented with a decision, she asks, "What would you do?" It can be the easy way to just simply answer -- you have experience, you know what you are comfortable with. But that would be taking away this family's experience of facing a tunnel of indecision and coming out the other side with an answer they feel fits for them. In the short run, you can look like a hero with the solution, but in the long run, that doesn't help this family build up their confidence in parenting and making choices for their baby.
3-Do I have strong feelings about choices families make regarding birth and parenting? I have a close friend who admitted she couldn't work with pregnant or new moms because she can't handle when they make choices she feels are wrong. Instead of trusting parents to make their own educated decisions, she wants to "bully" them into parenting as she does. For example, she has always co-slept with her babies, and it drove her mad to see parents put their babies in cribs. Instead of offering evidence-based information such as Dr. James McKenna's research, she wanted to jump to scare-tactics to push parents into making their decisions. This is not choice, this is force fueled by strong statements full of fear. We must trust families to make the choices they feel are right for their situations.
4-Do I include myself as an integral part of their birth story? I admit, it feels good when a family says, "We couldn't have done it without you!" And it would be great if I could really believe that and walk around with that feather in my doula cap. Maybe it's altruistic (more likely, insecurity!), but that doesn't rest well with me. I once read a birth story where the doula went on and on to list all the things she did (10+, all numbered and acknowledged) to make this birth experience amazing for the mom and dad. Did the parents walk away feeling the power of themselves and their baby? Or did they walk away feeling like without their doula, they would not have been equipped with the tools and strength to have their baby? My response in situations like these is the same: "You could have done it without me -- I could not have done it without you."
5-Do I have specific requirements for parents? I had a former doula client who moved states away after the birth of her first baby. She was pregnant again and interviewing doulas. She texted me: "Is it normal for doulas to say they will only take you as a client if you agree to specific things?" The doula they interviewed said, she taking them as clients would be contingent upon them taking "approved" childbirth classes, committing to breastfeeding, and signing a statement to say they would agree to "nighttime gentle parenting." This family already believes in breastfeeding and the family bed, but they weren't prepared to take additional classes. Equally upsetting was, they were prepared to interview the doula, and instead they felt they were the ones being interviewed. "This was not what we were looking for, it kind of goes against the reason we wanted a doula in the first place." After a few more interviews with different doulas, they were able to find one that better fit their family. Of course as doulas we need to take clients we also feel fit our needs, I understand that. The process, though, can still be about the parents while we quietly assess how the fit feels for us, and then act accordingly after the fact if we know we aren't the right doula for this family.
There are many ways we can shape the births of our clients, these are just a few to consider. Doulas, what other ways can we impose our birth footprint on our clients, and how can we best avoid these roadblocks? I would love to hear from you.
Tuesday night I was called to the home of N and J – N had been having contractions since 2 pm and now, 9 hours later, they decided it was time to go to the hospital. After being monitored and checked, and N being pronounced 1 centimeter dilated, they were sent home.
N continued having contractions and the next morning they were starting to pick up. Around noon, they headed back to the hospital and this time they were admitted – N’s dilation was now 3-4 centimeters. N coped beautifully, and J was one of the most connected partners I have ever seen. We took a walk around the hospital campus and noted such things as the cell phone tower that looks like a tree. N would pause during a contraction and lean into J, and then we would continue forward once the contraction had passed.
Around 6:30pm N was checked again and found to be 5 centimeters. Not what we wanted to hear! But N was motivated to stick with it even though she was tired. The shower worked well until the Jacuzzi tub was filled, and from about 8 until 10 that evening we were all stationed in the tub room. N was getting more relief than before, moving in the water to a hands and knees position during contractions, and then to a sitting position to rest.
N had been having intense back labor this whole time. It became obvious her little guy was in a posterior position. At 10pm, 32 hours into the process, N was checked and found to be 6ish centimeters open. Her midwife offered a couple of suggestions --one being to break the bulging bag of water to see if this helped labor and dilation, the other to assess the pressure of the contractions to see if, after all this time, their strength was adequate to make the necessary cervical changes. As their midwife spoke with N and J, answering questions, encouraging them to make the decisions they felt most comfortable with, and assuring them they had time to think about it all, she then left the room to let N and J talk it over. They decided to have N’s water broken, and N also wanted to try some pain medication.
With the bulging bag of water N was dilated to a 6.5, but once it was broken, she went back down to 5. This was disappointing news for N and J. After all these hours, though, the fast-acting narcotic pain medication was giving N a little bit of respite. Thankfully, N’s baby finally moved into a better position, relieving that unrelenting back pain. After 70 minutes or so of J and I standing vigil at the bed, and with the medication mostly worn off, N was found to be 8-9 centimeters. Her contractions never decreased in intensity or frequency and she was getting so close to being done!
At this point, J and I got her into the shower to sit on the ball. This is where the last of her cervix would melt away in preparation of the baby’s birth.
When we came out of the bathroom, J was feeling like pushing, and we were all happy to learn that yes, her cervix was gone. It was finally time to fill the birth tub!
J climbed in and, as she had many times before, she settled in to listen to her body’s signals. She began pushing. Their midwife said to Dad, “Hey, J – once the baby starts to come, do you want to help him out?” I don’t think this was something J ever imagined, and if the idea had been brought up at any other point than this precise moment, I wonder if he would have agreed so quickly? But the right question from the right person at the right time was the perfect set-up for this dad to help catch his baby.
N pushed on her hands and knees. In no time we saw the baby’s thick, dark hair waving in the water. Unlike the movies or television, N’s midwife relaxed and watched N follow her body’s cues. There was no “Push, push, push, pushpushpushPUSH!” –ing involved. All was quiet and peaceful as we eagerly waited to meet this baby.
At 3:05am, Baby Austin was born -- his daddy’s secure hands brought him up through the water to the safe harbor of his mommy’s chest. 37+ hours after labor began for this couple, they held their new baby and whispered elated words of joy and love to him.
The birth team worked incredibly well together, and the midwife was aptly soothing and intuitive. All of that aside, though, this couple was exquisite. When it's all said and done, this new family has their own story to tell, a story where no one else stood out as heroes except Mom and Dad. This couple shared an experience they will forever treasure: a long labor, on the longest day of the year, that brought them their summer solstice waterbaby.
♥ four young boys and a boy dog (offspring)