Chelsea is a great friend and doula. I had the opportunity to be her doula with her most recent baby, and maybe her text-doula with her baby before that! She has dealt with a lot, and she had crippling HG. Today, May 15th, is HG Awareness Day -- so I felt it was only appropriate to hare her thoughts on this.
I've taken a few days to think about what I wanted to write for HG awareness Day. I would like everyone to take their time reading this and try not to judge. Hyperemesis Gravidium is described as extreme morning sickness. But there are things that the public doesn't see -- things that our families and friends don't even see.
I vomited anywhere from 5 times on a good day to 40 times on a bad day. I battled daily to figure out what was safe that day to eat or drink, to find out most of the time the answer to the question was nothing. Nothing was safe to eat or drink, and attempting to would land you back in the bathroom in a endless cycle of vomiting.
Now here's the part you don't see:
You don't see when we are sitting on the floor, considering termination of our pregnancies, because we can't stand the thought of being this sick any longer -- considering giving up much-wanted babies because we feel like we're causing our husbands and kids to suffer along with us.
You don't see us wishing for a miscarriage, to end the constant torment of feeling like we're dying. You don't see the days where we question living anymore at all.
You don't see the deep dark hole of depression that we sometimes sink in to because we are missing life everyday. We give up family events. Moments with our other kids. Being angry at our husbands because we feel so sick and they're trying to help but sometimes it makes things worse.
You don't see the countless medicine bottles, ER trips, and IV bags.
You don't see the countless times, crying alone on the floor, scared we are harming our unborn babies with the medications that don't stop the sickness, but just help keep us both alive.
My family had to see me so sick I wanted to die, more then once. They had to see me pale and withering away. They had to see me cry, day after day, because I just didn't feel good ever.
I've thrown up in more public bathrooms and parking lots than I care to count. I've had to buy new shirts while we were out because I threw up all over the one I was wearing.
Did you know that toilet water has a distinct smell? We do. We smell everything. Your perfume. Your lunch you ate. It all makes us sick.
The smell of my kids when they played outside made me extremely ill.
I took the highest dose of zofran a person is allowed to take. I had to rotate meds. I had to fight to not get a PICC line IV. At the end I battled to keep a feeding tube out of my nose and a hospital admission out of my family's life. I had to tell my doctor no, because I had nowhere for my kids to go for such a long period of time.
I've done 4 HG pregnancies, my first and my fourth being the hardest. My last one, I lost 45 pounds and was sick the entire pregnancy. I never made it back to pre-pregnancy weight with him.
So please. I beg you. The next time you see a woman clearly suffering from HG, take a second to consider what she's going through. Don't try to force ginger, crackers, and natural remedies down her throat. Just love her and try to understand that her life at that moment is hard. Try to pitch in and help. Bring a meal for the rest of her family. Bring her a good book or movie. Maybe some comfy pajamas. I can tell you for certain, she'll appreciate your efforts.
Chelsea is a doula and the mom of four. She recently relocated from Bakersfield, CA to Tulare, CA. She tried desperately to breastfeed her babies, but it was always a struggle for them to gain weight. Between her 3rd and 4th babies, she learned her children all had tongue ties, affecting their abilities to nurse well and get enough milk. She had her most recent baby's tongue treated, and things got amazing after that -- now she is a fierce advocate. When she's not helping other moms, or suffering from HG (with 4 babies in 4 years, that has been a lot of time!), she and her family love going to Disneyland.
In my classes, I have an activity I am pretty sure I learned in my Passion For Birth training where parents are encouraged to draw their ideas for birth. Taking left-brain concepts (hospital stays and medical procedures) and using right-brain-directed activities (drawing and coloring) blends our thinking and enables us to synthesize ideas, versus analyze them. What's the difference? When you analyze something, you have a singular focus on it and it alone.
Imagine being worried about having an unneeded, unwanted, unwarned-about episiotomy. Analyzing this can lead to worrying it might happen to you, without much recourse or thought into the bigger picture of how to prepare to avoid it. Synthesizing takes many pieces of information and plugs them into a bigger picture. In the case of episiotomy, you can learn when they are medically necessary, ways to prevent them during labor (for example, avoiding getting over-hydrated) and second stage (avoiding purple pushing and being more upright), your doctor's opinion and habits, and your birth location's statistics.
Here are pictures from students in my Chico, CA classes (I currently offer Lamaze childbirth classes in Bakersfield, Visalia, Hanford, Tulare, and many places in between and beyond).
I like the labor length and time-line for being home and being at the hospital.
A collaboration by Mom and Dad. I loved what I called The Parthenon -- it actually did represent support! What a great way to draw such an intangible idea!
Very neat and organized! All we need are some boxes next to each item and this would be a great packing list!
Another picture a mom and dad drew together. See the stairs? They are scaling the wall. The rainbow on the right Dad said, "represents God's love and presence." So many great symbols!
"Ninja Birth." A dad-to-be drew this. He and his partner were on the same page of wanting a normal birth free of unneeded interventions. She was gentle and calm in her desires -- he pictured worst-case scenario, including ninjas and Chinese stars.
So of course, sometimes these pictures get silly. But when you remember the role of the partner is one of protector, it makes sense. As a group we process and interpret the images, and families share why they chose what they did and what it means to them. These pictures serve as a jumping-off point so parents can not only discuss what's important to them, but also how to achieve these goals.
And I promise, this last picture? This family had a lovely hospital waterbirth with a midwife -- and no ninjas were needed.
My older sister likes to remind me that once upon a time, while pregnant with my first, I responded to her question of, "Are you going to breastfeed?" with an unsure, "...if I can." To this day I still deny it. I honestly have no recollection whatsoever of that conversation -- I know she wouldn't make it up, though.
Over 16 years later, life has put me in a different place. I have successfully breastfeed my four children. Soon after my second baby's birth I went on to become a breastfeeding counselor, leading meetings for local mothers and mothers online, taking phone calls from frantic mothers all hours of the day and night, making home visits and hospital visits, and participating on our county's local breastfeeding coalition. I have written articles for journals, magazines, and blogs, spoken at breastfeeding conferences, and I am currently working toward becoming eligible to sit the exam to be an IBCLC. I cannot imagine who that person was who meekly replied, "...if I can," all those years ago.
Yet with all the future-breastfeeding moms out there, this is a common feeling. I think it stems from allowing a bit of room for failure -- not setting the bar too high in case of disappointment. Simply put, lowering expectations.
You only have to go as far as your nearest mother to find why this answer has held its place as, I would guess, the number one response: We love to share our horror stories. Any pregnant woman can attest to this when it comes to birth stories -- suddenly women are crawling out of the wood-work to tell you their impossible experiences -- the pain, the suffering, the horridness of it all, oh, and good luck! This carries over to breastfeeding experiences as well.
One day in the grocery store, a young clerk asked, while checking my items, if this was to be my first baby? I was prepared for her to launch into her personal drama, so with my fists clenched, and most likely talking through gritted teeth, I replied, "Yes." She looked at me so sweetly and honestly. "You are going to do just fine." I was stunned! She must have sensed this -- she went on to say, "Having my son was the best experience of my life. I wouldn't trade his birth for anything." I left for my car feeling like she had just revealed a secret to me -- I felt this young lady, about my age, had seen something in me I did not know I possessed. I felt powerful.
Birth and breastfeeding are related in the way we think about them both: We hope for the best, but in the end, we do not have ultimate control over how things will turn out. This tends to be more true for birth than for breastfeeding. Some of the most committed breastfeeding mothers I have met have been mothers who had to have cesarean births after planning completely natural births. I think many of them found exerting energy into the breastfeeding relationship healed the loss the cesarean birth left with them.
As women, we need to focus on sharing our positive feelings about birth and breastfeeding. We need to assure other mothers although there can be problems and set-backs, there is always a way to accommodate, adjust or overcome with the right network of support.
Let me share the biggest secret to a successful breastfeeding relationship: Know where to get help. You can always call me with your breastfeeding concerns. My doula role ends after your baby's birth, but my role as your breastfeeding counselor continues until you no longer need me.
I help breastfeeding moms with lactation support in the Bakersfield, Visalia, Tulare, and Hanford areas of California's Central Valley. So often when I answer the phone to a mom looking for breastfeeding support, somewhere in there I hear the voice-cracking and the tell-tale pauses that show she is working hard just to reach out and share her story. We are often not prepared for how hard breastfeeding can be, and the toll it can take on our hearts. We hear of the joy babies bring, the bonding, their smell, their sweetness -- maybe someone out there mentioned being really tired or not showering easily in the first weeks. We are culturally conditioned to worry more about birth than breastfeeding.
When a mom is struggling, what can we do to lift her up? What words and actions can scaffold her, infuse her with strength? I asked women to think back to what was encouraging and motivating, that anyone (not just a breastfeeding helper) could do, to make the journey a little easier. Here is what was shared:
1. "Keep the focus on me." Many of us have had issues with breastfeeding, and often the inclination is to quickly get to our own story and how we survived. "I cracked and bled for two weeks. I didn't have enough milk so my friends gave me donor milk. I locked myself in a room and said, 'we will figure this out,' and I never gave him a drop of formula, even though my doctor suggested I was starving him -- I just powered through." This is not helpful. It isn't that on a normal day Mom can't appreciate your experience, it's just that right now, it takes away from her very-current state of being vulnerable and needing support. If you can relate, say something simple that doesn't turn the whole subject back to you, like, "I remember that." It's okay to reaffirm you have felt something similar; it's not okay to shift the focus so now you can talk about yourself. In this moment, it needs to be all about Mom and Baby. It takes acute awareness to stay in the present with her, and this truly is your gift to give.
What is not helpful: Launching into your own tale of triumph, terror, or failure, especially with the intent of showing Mom you had it worse; the same holds true if you feel compelled to share your grief, your anger, or what you would do. Apply Susan Silk's "Ring Theory," which I have adapted. The idea is, the person facing the crisis (Mom) has the center spot. She is allowed to say whatever she wants or needs to, to anyone else. As the rings extend, others are assigned positions according to how close they are to the center. So Mom's partner is next. Again, he or she is allowed to vent in an outward fashion. Family and friends will have their own feelings, and it is appropriate to dump those outward as well. Advising, sharing your worries or coping methods, explaining your exasperation with the situation, etc., is never done inwardly, because this adds to the load of those dealing most directly with the crisis.
2. "Use those active listening skills we hear about." Rephrase what she says: "It sounds like you are scared that breastfeeding is not going to work." By restating what you heard, you aren't going to tell her something she doesn't already know, and it lets her know you heard her. If it isn't what she's feeling, she can clarify by offering more information: "No, I feel like it is working, I just think maybe it will never end up being a smooth, easy process, like I imagined." It's okay if you don't get it right -- she will understand you are trying to listen to her feelings. Acknowledge her struggle -- you can never go wrong by saying something like, "I see how hard you are working." Don't ever under-estimate the therapeutic power of being a good listener.
What is not helpful: "Maybe it's not meant to be." "Haven't you tried hard enough?" "Formula/ bottles are here for a reason." "Your cousin Jill wasn't able to breastfeed, and everything turned out fine for her."
3. "Don't be afraid to touch me." When the dam holding back the tears and feelings breaks, she can feel cracked open and raw, and having an audience can make those feelings even worse. You can touch her shoulder, take her hand, or offer the comfort of a hug. Sometimes touch can give more solid support than any words can. When a baby cries, he is letting us know he needs something, and that gives us the opportunity to respond and help him feel better. When adults cry, there is the same opportunity to help someone feel better while also creating a bond of love or friendship. You may not know what to say when you see her like that, but you can't go wrong by showing her physically that you care.
What is not helpful: Staring at her, pretending she's not showing emotion, visibly looking uncomfortable, or telling her not to cry.
4. "Share in the loss I am experiencing." Whether breastfeeding will ever work for Mom and Baby, in the middle of the crisis, it is a loss -- a loss of hopes, a loss of dreams, a loss of what she thought would be an "easy and natural" way to feed her baby. It is okay to treat this as any loss a friend might face. This isn't the same as having two choices for dinner -- chicken and rice or beef and potatoes -- and then having the choice made for you. Breastfeeding comes with many overwhelming emotions. When she feels like she can't feed her baby, in that moment there is nothing that can feel worse, and it feels like loss. We can accept and value that, even if we can't understand it.
What is not helpful: "It could be worse." "At least you have a healthy baby." "I don't understand why this is affecting you so much, it's not like someone died."
5. "Let me decide when I am done." Well-meaning friends and relatives who are concerned about Mom's physical and emotional well-being may try to convince her that she's worked hard enough. Mom is the only one who can judge that -- she knows her options. Wait for her to tell you where she is in this journey. One woman, a neurologist, shared: "If you say you are suicidal, people don't say, 'yeah...you should probably just go ahead...' They figure out how to help you, they talk you off the ledge." It obviously isn't the same thing, but in the storm of hormones, emotions, life changes, and struggles, the very-real feelings of hopelessness and loss of control can be strong and similar. Keep encouraging her. This is her marathon to run -- she decides the pace, the route, when to take a break, or even when to stop -- you cheer her on from the side no matter where she is in that loop, no matter how you are feeling about her situation. As another woman put it: "It's cruel to try to take someone's hope away."
What is not helpful: "It's unlikely by this age your baby is going to figure out how to breastfeed." "Just try X, Y, or Z -- it fixed our issues." "Not everyone can breastfeed." " I just can't bear seeing you so upset."
6. "Do something for me that will save me from having to do it myself." Rabbi Harold Kushner is the author of, "When Bad Things Happen to Good People." When asked to share what he's learned in his years supporting people in the midst of suffering, he said it could all be summed up in this statement: "Show up and shut up." Anything you can do for Mom that gives her more time to be with her baby and concentrate on self-help and healing, is priceless -- and ANYONE can help. "My husband has always been supportive. He always left it up to me to decide what I wanted to do. And when I decided I wanted to continue to try, he helped me pack up the baby and drove me to LC's and LLL several times a week. He washes bottles and pump parts, he's a pro at freezing, thawing, making bottles, hooking up my pump. His labor of love is so important at continuing exclusive pumping, because I alone have logged about 3,000 hours of work towards pumping and pumping-related activities for the first year of my baby's life." Further out of the ring, family and friends can take care of pets or outside responsibilities, bring meals or snacks, run errands, make phone calls, drive Mom and Baby to appointments, and always, always there is housework and laundry.
Ronald A. Rasband shared: "If you come upon a person who is drowning, would you ask if they need help -- or would it be better to just jump in and save them from the deepening waters? The offer, while well-meaning and often given, 'Let me know if I can help,' is really no help at all." It can take energy, effort, and humility for a person to list what she could use help with. In the movie "Robots," one of the characters, Bigweld, had this motto: "See a need, fill a need." Jump in and do what you can -- when there seems to be nothing else, there is always service.
What is not helpful: Service with conditions; making the job seem too complicated to take on, or making it too complicated for Mom to delegate; rushing in to offer babycare when Mom and Baby could be bonding; expecting a thank you card.
Society says feeling bad when breastfeeding is hard is not appropriate or okay. We don't want to make anyone feel bad if they can't breastfeed, so when a woman struggles to continue, her hard work is not always encouraged or even noticed. To really help, though, we need to suspend this judgement and be willing to accept her feelings and her reality. Becky Bailey writes: " Acceptance means recognizing that people, situations, and events are what they are. Each moment simply is as it is. Acceptance doesn't mean that we approve of the moment, only that we recognize that what is happening at a certain moment is, in fact, happening."
Two women in particular said they couldn't remember anything helpful or hopeful that was said to them. This lack of acceptance is apparent when they shared what they wished they had been told:
"This is the hardest thing you will ever do, but you will get through it. You are getting through it. One day at a time. You are amazing and strong and this will be worth it. It does matter."
"I support you and will be here to help you if you decide to keep trying or you want to stop. I value you and think highly of you as a mother and person, no matter your decision."
Accept her struggle. Accept her feelings. Open yourself to her reality and you increase her willingness to accept your help. When she comes out the other side (whatever that other side looks like), it can be with positive memories of the support and care that was shown to her and her baby.
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Just good, old-fashioned, doula praise! Sometimes it doesn't get better than that! The doulas shared here are Coleen Salazar and Avira Wenn.
In the beginning of my pregnancy, I didn't even know what a doula was. I honestly met a doula while serving on a jury. While on a break in Visalia, CA, Coleen approached me. I was reading Ina May’s Guide to Childbirth, and it peaked her interest about me. We began to talk about birth, my pregnancy, and the struggles I was having with trying to get my OB on board with the natural birth I wanted. We talked at great length, and I loved everything about her so much that I kept in contact with her.
In addition to being a doula, Coleen was also a lactation consultant at a hospital in Tulare, so she invited me to a free class she was teaching on breastfeeding. I went to the class and found out the it was part of a local birth network. From that day on, I became very involved in the birth network. I began to educate myself on natural birth, breastfeeding, and various other birth related topics. In my third trimester, I also left my OB and switched to a midwife who was totally on board with the way I wanted to birth.
Although I had learned a great deal about birth, and switched to a midwife, I still wasn't sure I really needed a doula. However, I really wanted Coleen at my birth because she was the first person, throughout my entire pregnancy, that made me feel completely confident in my decision surrounding my plan for a natural birth. When I asked her about being my doula, she told me about her friend, Avira, who was finalizing her doula certification. She needed to attend births in order to fulfill her requirements. Coleen encouraged me to be open to the idea of having two doulas.
After meeting Avira, I couldn’t say no! She had such a calming presence that proved to be amazingly beneficial during my birth. I feel very fortunate to have had two doulas by my side. Although I hired them late in my pregnancy, they still came to my house to discuss their role in my birth, nutrition, my birth plan, and further educate me on birth options I didn’t even know existed (delayed cord clamping, passing on standard but unnecessary needle pokes, etc.). I was on a tight budget, but they were committed to helping me have the birth I wanted and worked with me on payments.
Both Avira and Coleen were by my side through my entire labor. Avira literally supported me through some of my contractions and massaged my back during the most intense parts of my back labor. She knew just what to say and how to touch me. Coleen knew just how to motivate me when my contractions were tough. She encouraged me, kept me hydrated, helped me with positioning during contractions, and helped me know when I should transfer to the hospital.
Their job as doulas was to be completely in tune to my needs, and they were. I consider my doula experience completely invaluable! I really don't know what I would have done without either of them by my side. My daughter had better care due to my doulas, I had the birth I envisioned for myself, and I was able to successfully breastfeed my daughter due to Coleen’s breastfeeding expertise (still going at nearly two)!
I had amazing postpartum care as well. When I needed anything, or had questions, they were there for me. They both came to my house and stayed with me while having some issues with my daughter nursing. They helped me through some of the toughest times I’ve had. The only other person as fully devoted to me throughout my entire experience was my husband. I'm so glad I made the choice to have a doula, and I don't plan on birthing anymore babies without one. I will be forever grateful to both of them for supporting me through such an amazing time in my life.
This week I received notification that I, once again, passed the Lamaze International certifying exam (making me the only listed LCCE in Bakersfield, one of two in Visalia). In light of that, I was curious to know why as doulas and educators, we choose to extend the extra effort and resources to gain and keep these initials after our names? Sharon Muza offers her thoughts to this topic. Additional quotes follow from not only doulas, but also mothers. And my answer? Grievance policy, as strange as that sounds -- I appreciate DONA offering this, as it protects my clients, and it protects me.
I am both a certified doula with DONA International, CD(DONA), and a certified childbirth educator with Lamaze International, LCCE. I am very proud of the fact that I hold and maintain these certifications. I worked hard for them and it means a lot for me to have these credentials. Here are my top six reasons for certifying AND maintaining certification with well-known, long-standing, internationally recognized organizations:
1. Demonstrates my serious commitment to being recognized as a professional doula and childbirth educator.
2. Assures my clients, students, my colleagues and the health care providers that I work with that I have successfully completed the requirements for certifications as set forth by my certifying organizations.
3. My clients, students, my colleagues and HCPs are assured that I abide by and practice according to the standards of practice and code of ethics that have been established by well-known and well-respected certifying organizations.
4. It allows me to support the organizations that I believe in, with my membership and certification dollars, allowing them to work toward improving maternal infant health outcomes as a serious player on the national and international level with my support.
5. Maintaining recertification shows my commitment to receiving continuing education that is current and applicable, and demonstrates my desire to remain up to date with best practices.
6. Provides a grievance process for clients, students, colleagues and HCPs who might have concerns about my practice standards, actions or ethical behavior.
I am very proud that I am a certified birth doula with DONA International and a Lamaze Certified Childbirth Educator. I look forward to continuing to maintain these certification in the years to come. I encourage you to seek out reputable and well-respected organizations to align yourself with and pursue certification in a professional manner.
Sharon Muza, BS, CD(DONA) BDT(DONA), LCCE, FACCE has been an active childbirth professional since 2004, teaching Lamaze classes and providing doula services to hundreds of couples through her private practice in Seattle, Washington. She is an instructor at the Simkin Center, Bastyr University where she is a birth doula trainer. Sharon is also a trainer with Passion for Birth, a Lamaze-Accredited Childbirth Educator Program. Sharon is a former co-leader of the International Cesarean Awareness Network’s (ICAN) Seattle Chapter, and a former board member of PALS Doulas and Past President of REACHE. In September 2011, Sharon was admitted as a Fellow to the Academy of Certified Childbirth Educators. Sharon Muza has been the community manager, writer and editor for Science & Sensibility, Lamaze International’s blog for birth professionals, since 2012. Sharon enjoys active online engagement and facilitating discussion around best practice, current research and its practical application to community standards and actions by health care providers, and how that affects families in the childbearing year. Sharon has been a dynamic speaker at international conferences on topics of interest to birth professionals and enjoys collaborating with others to share ideas and information that benefit birth professionals and families. To learn more about Sharon, you are invited to visit her website, SharonMuza.com.
I have been a couple of days ahead of these 31 days' posts. Yesterday, on day 8, I was ready through Tuesday, including a special Mother's Day post for day 10. All I needed to do upon waking up today was hit "publish" for day 9's post.
I was called to a laboring mom in Tulare at 2 am, yet I knew I could use my website's mobile app to publish from the hospital -- but not so, I kept getting an error message (while mom was being triaged in a Visalia hospital and I was in the waiting room). I finally gave up and focused on this birth, knowing I could figure it out later.
This birth! This birth was amazing. My friend and fellow doula, Denise, asked me to support her during her surrogacy birth. Her husband, Chris, was a huge helper -- after all, he has supported her through her natural births before. That left me wondering, what would my place be when the partner is already doing great? I did doula the dog while we labored at their house; poor Buddy had been hiding under the bed until I arrived. I walked in to lay my hands on Denise's back to let her know I was there, and from under the bed, something began licking my feet. Buddy!
What we couldn't predict was, once we got to the hospital, Chris started feeling very sick to his stomach. He needed to go to the car and rest for a while, and he was kind of in and out of the scene. When he was present, he was very present, offering everything he could to support Denise (and the way they worked together was inspiring). And when he needed to step out, he knew things would be okay.
Denise had an amazing midwife, Rita. Rita is a powerhouse. She had five children of her own, and when she enrolled in a midwifery program Stanford offered for three years back in the 80s, she was pregnant with her 4th baby. Many doubted she would finish, but Rita is nothing if not relentless! And this shows when it comes to supporting her patients. Not only did she go to bat for Denise's comfort and preferences, she also knew how to talk to Denise to keep her courage up and help her move forward when she hit emotional and physical walls.
The intended mother was at the birth, and she quietly witnessed the whole thing, very concerned for Denise's safety and comfort. When this little baby girl was finally born, she was laid on Denise's chest, with her mom right there, awestruck and deeply moved. I don't think any one of us in the room had dry eyes. Soon the mother sat down in a rocking chair and baby was placed skin-to-skin with her. We all watched this new mother interact with her baby -- the sweet words, the lilting voice, the facial expressions and the snuggling; it was an amazing peek into the private world of a mom and her infant. Soon the new dad joined mom and baby, and again, the tender voices and touches were sweet affirmations to those present that this new gift was one worked hard for, one cherished.
I didn't intend for this to be anything more than a short Day 9 post to stay on track, but it is hard to withhold the beauty of birth -- every birth. I am amazed at Denise's strength and her generosity. She truly went through one of the hardest physical and emotional experiences in her life to grow and birth a baby for a family who did not have this ability. Four hours or so after the baby's birth I finally left, but one of Denise's last comments to me was this: "I am so grateful I could do this for them."
And I am amazed.
♥ four young boys and a boy dog (offspring)