I know as a doula and birth professional who works with hundreds of families a year, there will always be families who want a doula who has the most experience at a higher price tag, and there will always be families who are happy to work with a less-experienced doula at a lower price tag. There is no right or wrong, there is just what is right for you.
Doulas aren’t like other professions we may sometimes link them to – take nurses, for example. You understand when you have need of a nurse that they all met a standard competency, and they all work to keep that license up. Even if your nurse went to school in Washington, or Florida, or the Netherlands, there are core competencies all nurses are expected to learn. There can be some slight variations, but for the most part, the educational requirements are similar.
In contrast, according to DoulaMatch.net there are over 120 doula training organizations. This means there are over 120 different ways to become a doula! The hard part is figuring out just what the training, certification, and experience means. When we look at websites or Facebook pages, doulas can pretty much appear the same. Each organization has different requirements for doulas to carry their names. Here are just a few of these:
I certified as a doula with DONA International in 2004. At that time, there were very few organizations to choose from. Now the amount is staggering! I think I would have still chosen DONA today as my values and what I wanted from a certifying organization hava not changed.
Many people don’t want the pressure of a governing organization hanging overhead. I have met so many people as a birth professional, and one thing that always amazes me is the wide variety of jobs out there! In learning about families’ occupations, I have found it is not unusual to have a professional agency, governing board, or larger organization that steers how people do their jobs. Architects, Realtors, Doctors, Cal Trans Workers, College Professors, Sandwich Makers, Day Care Workers, Teachers, Linemen, Physical Therapists, Lawyers, Dairymen, Nurses, Pharmacists, Landscapers, and even Doulas (I have a lot of clients who are doulas!), have organizations above them that offer scaffolding and organization.
I am a lone doula, and this I what DONA offers me – DONA gives me information, education, and support to aid me in doing my job. DONA sets expectations, they disseminate new evidence and educational opportunities, they create routes to streamline my work. DONA looks out for me, so I can look out for my clients, and that is why I stick with them.
After writing this, I realized Kim James offers much of this paralleled information on DoulaMatch.net. She has laid it our more succinctly and without bias; refer to her page to see more ideas about what information you’d like to know about your doula candidates.
For you doulas out there, who did you certify through, and what led you to that decision? Share what you love!
I have often thought I need that wonderful old t-shirt, "Frankie say relax!", to wear when I am teaching classes or attending a birth. Could you imagine? I often joke that telling someone to relax is like telling someone to calm down -- it isn't helpful, it irritates people, and it often feels accusatory or as if someone overreacted to something. In labor we must learn when to actively relax, and when to work -- here Connie offers her thoughts on the subject.
If you were to believe the movies –- coping in labor means that you look like “The Buddha of Birth.” You sit in a lotus position, gently breathing, eyes closed. People in the birthing room often think that if the laboring person is doing well, they are completely quiet and deeply relaxed during each contraction.
While that might be nice, it is an unrealistic expectation of someone who is working hard! And that is what Labor is – Work! When I go to the gym, I see lots of people working hard. They don’t look relaxed at all. They make noises, move around and look to others for encouragement and assistance. Why do we expect less of a person giving birth?
Real coping in labor often looks and sounds like someone at the gym, especially during a contraction. But remember, a contraction lasts for about a minute. Then there will be several minutes that there is No Work to Be Done because the contraction is over. That is when we can relax!
Having a doula there to remind to you let go, release, and relax between contractions helps you to feel more in control. It allows you to rest and restore, so that when the next contraction comes, you have more energy to work with it -- more confidence and less fear.
It may help between contractions to think: “My forehead is relaxed. My shoulders are dropped. I sink down into my pillow. I am at rest.” Your support team can say these words to you to help you relax when you actually need to. In this way, then (if you want to be!) you can be “The Buddha of Birth”!
Connie Sultana is grateful to the 900 families that have taught her about relaxation in birth. Connie is a DONA Birth Doula Trainer, former member of the Board of Directors of DONA, a Lamaze Childbirth Educator and a trainer for Passion for Birth, a Lamaze Accredited Childbirth Educator Training. Learn more about her by visiting her website.
Full-disclosure: I know Allie very well. I even wrote her bio as she is currently out of town at a competitive archery event. I hope I didn't get carried away -- there are a hundred more things I could say about this incredible lady, and I tried to be succinct. Her birth was an incredible journey of strength and surrender. Her husband worked like he had been a doula all his life! The birth team was around, trying to help whenever we could, but Kyle mainly stood at the helm like this was something he did every day. We joked that he needed an honorary doula certification after that. Also on the birth team were midwife LaMonica Bryant, doula and birth photographer Ellie Kolb, and back-up midwife Rachel Donckels. Special thanks to Ellie for allowing her pictures to be shared here.
I had been a doula for over a year when I found out I was pregnant. I was so excited to be on this journey I had fallen in love with and learned so much about. Growing a baby inside my body was everything I had imagined it would be. I had a fairly easy pregnancy, lots of support from my husband, family, and friends that were also birth workers. I had access to tons of information and enjoyed immersing myself even more deeply into all things birth related. I was watching livestreamed births, listening to podcasts, and reading all the books!
We established care with a local midwife and planned to have a home birth. My husband was a little unsure at first, until he met LaMonica, and after that first meeting we knew we were in good hands. Our families, however, were not so excited about it. For the majority of my pregnancy I had to answer questions like “when will you see a doctor?” or “at what point will you go to the hospital?” Not having 100% support was hard, but I knew that I had made an educated decision that was right for me.
At 37 weeks my husband got sent out of town for work five hours away! To say I was stressed is an understatement. I knew after he left it could be any day or another month before we met our baby. I tried to plan activities to keep myself busy, but I also allowed for lots of rest time too. My husband did make it home, and I was still pregnant – but not for long.
It was a Friday morning and I was 40 weeks and 6 days. We decided to check off all the things on the to-do list before we ran out of time. While we were out and about I had some crampy sensations but nothing that made me stop in my tracks. We walked around Costco and joked about all the free things we might get if I had my baby in the store. We also joked that we had to be out and about because if my water was going to break, it would probably be in a very public place. My goal for postpartum was to just relax and spend time cuddling with our new baby and watch lots of Netflix – we bought a new TV and headed back home to get it set up.
By that time I was still feeling some cramps and decided to sit for a bit and drink some water. It wasn’t too much longer and I was having to pause a bit, and I was only able to squeak out maybe one word during each contraction. “Yes,” “No,” “Wait,” “Shhhhh.” I knew it was probably the real thing, but I didn’t want to be the girl who cried wolf, so we timed them for an hour or so and I drank lots of water. They were about 7-10 minutes apart. It was now about 8 pm and contractions were still happening. Kyle was so excited! He wanted to set up the birth tub right then, but I told him to wait. I really wanted to make sure it was the real deal.
I texted my birth team to give them plenty of notice that this could be the night. They of course advised me to eat, drink, and sleep. So we ate a super nutritious meal of hot dog sandwiches and headed to bed. I had two contractions while lying in bed. They were torture. I got on all fours or leaned over the bed to have contractions. I knew this wasn’t stopping -- the big moment I had waited for was finally happening. All the wondering of what my birth story would look like was being solidified with each breath I took. I let my husband sleep while I labored. I went out in the living room. The glow of the Christmas tree lit up all three of our stockings. The dog was asleep on the couch and the house was quiet. I felt like it was just me and my baby, working together at the start of our journey. But soon the contractions were coming pretty fast and getting much more intense. I was going to need some help.
I woke my husband and said it was time to get ready. He jumped out of bed happier than a kid on Christmas and got the tub set up. I again alerted my birth team, letting them know the update. As a doula myself, I know how it is to be on call, so I wanted to keep them in the loop as much as possible. I also had lots of early labor activities planned, so after the tub was filled we started that list. First up: making birthday cupcakes.
I got the box out of the pantry and brought it to the kitchen, then I had a contraction. Kyle opened it and got all the ingredients in the bowl. I mixed it together, and then I had another contraction. This wasn’t going as I planned in my head. He got the cupcake liners ready. I poured TWO cupcakes and had another contraction. He finished pouring the mix and popped them in the oven. So much for baking! At least that task was done and kept him busy.
Next on the list was writing a letter to my baby. Something I had always thought was a sweet idea, but at this point I couldn’t even think of sitting down and putting pen to paper. Sorry baby, I’ll tell ya about it later!
I asked Kyle if we should call my doula, Stacie. Each contraction was becoming lots of work and took a lot of focus. I knew I was progressing and things were changing but I was not sure how fast. Sometimes I even got waves of nausea. We decided to call her. While on the phone I heard myself, and as a doula, I probably would have been thinking, this person is not even close, but Stacie is very patient and kind and she agreed to come over.
When she arrived we were smiling and laughing and filling her in on all the things we had done. She watched me cope through contractions and reassured me that I was doing well. It was as if I could step back and see myself and think I don’t “look” like how I’m feeling. It felt like things were much more intense, but I was just swaying and breathing and not looking like much was going on. I told Kyle to get the bucket out of the pantry in case I threw up. I think he and Stacie thought I was crazy, but sure enough a few contractions later I said goodbye to my dinner.
Stacie asked where my birth kit was and suggested we contact the others. I agreed. From my studies I knew nausea was a sign of transition and thought to myself, man I’m doing great! This is hard work, but I totally got this no problem. A few more hours and we should be done. Turns out I was not one of these blessed people with a short labor.
The sun was coming up, and the rest of my birth team arrived. I was so excited to see them and I was thinking the end was near! I opted to have my midwife check my progress. I was at 6cm and baby was still pretty high. Fun fact: she never really engaged like a typical first-time experiences. I wondered if perhaps she had a short cord, and I hoped that it didn’t mean there was anything wrong. So I kept on laboring, took a few laps around the pool in the crisp morning air with Kyle, and we called our parents to let them know we would be having our baby soon.
With the whole team there, my hubby at my side, and our families notified, it felt so real! I wasn’t a statistic, or a number, this was my experience. We were welcoming our first baby, the moment I had spent so much time dreaming about, and it was so real! Tears filled my eyes, and I was so grateful that this was it, surrounded by so many people who loved me and believed in my ability to give birth.
The next hours all blurred together as I transcended deeper into laborland. Yet I remember things being so clear in the moment. In and out of the tub, in the shower, doing laps around the swimming pool and lunges on the diving board. There was never a moment that I felt alone. There was always someone close by with whatever I needed -- a sip of water, a bucket to spit in, a towel to dry me off, or reassuring words that filled my heart. Kyle was such a good sport holding my hand when I was in the tub, holding me up when I leaned on him, and running water over my back in the shower. My doula offered me kind words of wisdom and she took care of Kyle too. And my midwife, LaMonica, watching over me and gently ensuring that my baby and I were safe.
After what felt like forever, a few cuss words, lots of position changes and some prayers, it was time to push!
When I tell people I had a homebirth they almost always ask if I had my baby in the tub. The beauty of homebirth is that you can be wherever you want to be! I found my way to my bed when it was time for my baby to join us. Everyone supported me silently. There was no rush, just me and my baby as my body stretched and worked to birth this tiny miracle. Kyle was right by my side rubbing my back, kissing me, and telling me I was amazing. Every person deserves this kind of love!
After about 20 hours, Maddie’s head emerged still covered with the amniotic sac. LaMonica’s hands caught her as I pushed her out -- not pulling, but guiding with love as she told me to keep going. She wiped Maddie’s face. Maddie opened her eyes and started crying before she was all the way out. As soon as Maddie was out, I rolled over to meet her. She was crying and looking at us, Kyle and I were looking at her and at each other. There were lots of kisses and cheers and many tears of joy. Maddie was here and all the hard work had paid off!
That first hour went so fast, we were so in awe of her. She was so aware and talkative. I nursed her, and cuddled her, and talked to her about our shared journey. Then I got up to take a shower. My midwife made sure I was safe while I cleaned myself up, Kyle got to snuggle his baby girl, and somehow, magically, my room transformed from a place of birth back into our bedroom. As a family, we jumped back into bed and invited in our families to meet our baby!
Allie Baker, CD(DONA), LCCE is a woman of many talents and facets. She truly loves those she serves, and her ability to balance knowledge with heart makes her a well-rounded doula and educator. Allie's sense of humor and ease spreads to those around her, and this adds to her effectiveness in the birth world. Allie has continued her journey by gaining a thorough lactation education, working toward someday becoming an IBCLC. Her creative teaching ideas have been featured in Lamaze's "Science and Sensibility," and she brings that same energy to families. An avid lover of the outdoors, her family enjoys bow-hunting, camping, zooming around on sand dunes, and the occasional fun run. Since becoming a mother, she has reduced her doula load and focused on childbirth education, teaching regularly at The Nest & Co. in Bakersfield, CA.
In 2014 I shared an opening activity, What's in Your Head? I use this as a way to help families share their concerns and fears about pregnancy, birth, babies, feeding babies, and becoming parents. It helps folks see they aren't alone in the things that might be keeping them awake at night.
Looking for variation, I recreated this idea with Legos -- little plastic building toys we have amassed numerous buckets of over the years. All of these were pulled from our private collection, although the compromise with my kids was to put them in tiny zippy bags so things wouldn't get lost. The first time I did this activity, I passed the Lego head around and had each person pull out a zippy bag and share what they thought the toys might represent. In my next series, I decided to include a card with a general worry that related to the item in the zippy bag. I had participants look at the item first and see if it reminded them of any concerns they had, and if they were stumped, they could read the card. Then we go around the group and share our items and what they might represent.
I have this idea that people having babies these days are very well-acquainted with Legos. When I pull out the head, I see faces light up. Folks dig around, looking for a good one to grab. Sometimes they take them out of the bag and touch and move the items. This fun, creative approach to digging down and sharing things we worry about (and seeing we aren't alone) bonds us as a group. Be sure to read the original activity I linked above to get more ins and outs of how to finesse this activity.
And have fun in your teaching!
I recently stumbled upon a gem of an article which examines pushing positions for the second stage of labor. It was published in 1987 by the American Journal of Public Health. The author, Lauren Dundes, MHS, maintains our traditional Western lithotomy position (person on their back with feet up in stirrups) was never based on any sort of evidence. What it was based on were things like:
As a doula, it is not unusual for me to see laboring folks who start to feel like pushing when they are in an upright position, such as in the shower or on the toilet. The pressure remains between contractions, building; the person wants to push, and they are told to stop and wait for their provider. When the provider arrives the laboring patient is told to get into lithotomy position and resume pushing. Suddenly the urge seems gone! Whereas the person was just being told, "baby's right here, pant and blow, your doctor is just parking the car..." now it seems to have fizzled out.
The person may have lost the pressure to push, but the pressure to not waste the provider's time has just begun.
It's a tricky thing, gauging when to call the provider, hoping they won't need to be there too long -- especially if they are trying to keep appointments at their office. So we get the patient into the stirrups, we tell them to "curl around their baby, like a cat," grab their legs behind their knees, and "pushpushpushpushPUUUUUUSHHHHH!!!!" It's no surprise after some ineffective pushing and a baby low in the pelvis, the vacuum comes out and helps birth the baby.
But back to this lovely article. Did you know an "accoucheur" was a male birth attendant? There's your one to grow on so you capture the meaning of this quote:
"The British practitioner almost invariably directs the patient to be placed upon her side . . . while the Continental accoucheur has her placed on her back...the woman should be placed so as to give the least possible hinderance to the operations of the accoucheur-this is agreed upon by all; but there exist a diversity of opinion, what that position is. Some recommended the side; others the knees, and others the back. I coincide with the latter.... Therefore, when practicable, I would recommend she should be placed upon her back, both for convenience and safety" (bold mine).
In the 1830s, in America, there was a man named William Pott Dewees. He was the Chairman of Obstetrics at University of Pennslyvania. Let me break here to ask: am I the only one surprised that there was not only a university, but also one with an obstetrics department, in the early 1800s? I mean, weren't Paul Revere and tea tariffs just a backwards' glance? But a university there was, and Mr. Dewees published the former quote.
What stands out to me is the directive to adapt to the person catching the baby! Oh, I'm sorry, accoucheur, that you have to stand in that awkward position while you attend to a person who has gone through hours of an arduous, physical, stripping activity and they are about to split and spit another human being out, pardon my French. But by all means, let us make you more comfortable!
Speaking of French, there was another quote that shows where cultural beliefs came into birthing positions: "...it is reported that women in the United States lie flat on their backs, French women lie back on an inclined plane, English women lie on their left side, and German women use the birthing chair."
This was paraphrased from an obstetrics book published in 1884 by a man named Cazeaux. Interestingly enough, you can allegedly download this tome from Amazon for free? I didn't fall into that rabbit hole, but perhaps you may?
Dundes sums up her piece by stating lithotomy position was "implemented without verifying its appropriateness." She goes on to implore more research into this position. She writes that more families are "exercising their rights to actively participate in the birth experience...to make it a more personal and more physiologically and psychologically advantageous experience." Remember this was published in 1987! I imagine Dundes was hopeful change would come and birthing people would finally get off their backs.
Back to the future, huh? In 2019, the birth world I see pretty much matches up with Dundes' descriptions of the 80s. It doesn't seem to matter that we have more current evidence about positions for second stage, what I see over 95% of the time is a person put into lithotomy positon when it's time to push. When I see folks birthing in other positions it's usually one of three things:
If you live in an area where providers are resistant to more physiological birth positions, does that mean you're doomed to birth in the position of a dead cockroach? How can you advocate for yourself?
I recall one birth where the parent had a history of painful back issues. She labored on her hands and knees, and when the provider walked in they looked at her and said: "I can't deliver a baby in that position." This parent was able to communicate to the provider what she needed and had her baby in a way that worked the best for her body -- and this was a provider she had never met before.
I remember another birth where we tried a number of positions to help the parent bring the baby down. Ultimately what worked was lithotomy. The midwife turned to me and said, "we try to stay away from this one, but sometimes it's just what a person needs." The key to this second-stage tangle is right there: just what a person needs. We can get just what we need during labor and birth, and part of that is selecting a pushing position we are satisfied with.
I recently had the opportunity to be part of a training for a local hospital's BFHI process. I wanted a tactile way for people to feel the differences in palate shapes. Needing the models to be comparable to a newborn's mouth-size, I had the idea of using plastic spoons.
1. I used an air-drying clay and I formed different shapes onto the spoons. They dried overnight without shrinking, which was great since I hadn't put much thought into my supplies. I then used a cement glue to adhere the forms to the plastic spoons. This was all pretty easy stuff. Originally I planned to make lower gums as well, hence the spoons with just the gum-lines. I imagined putting the spoons together with palate-spoon facing the gum-spoon, and adding a tongue in between (balloon with Play-Doh in it so it was flexible). I didn't end up following through with the complete mouth as it wasn't crucial to the skills I was teaching.
2. Up until now this was all pretty simple stuff. But I wanted a coating over the forms, so I decided to use balloons, and this is where it got tricky. I used water balloons, and I had to not only stretch them over the spoons and forms without them breaking, I also had to use the cement glue to ensure the balloons were tightly applied to the forms' odd shapes. The bubble-palate balloon kept pulling away. I had to go through a few balloons because they kept tearing, and then I had to keep my thumb in the bubble for a few minutes to allow for the glue to really grab hold of the balloon. Also the glue is messy, and it will get all over your fingers and your project -- try to wipe it off the spoons ASAP because it is hard to get off the latex later.
3. Overall the process was pretty easy, and I created an ideal-shaped palate (u-shaped and gently sloping from front to back), a bubble palate, a v-shaped palate, and a channel palate.
4. This is how I had participants engage with the spoons -- in a similar fashion as when they are engaging with a real baby's palate, from underneath. The feedback from folks was excellent. The nurses appreciated the variations present, right next to each other, so they had immediate comparisons. Most admitted they never felt a baby's palate except to rule out a cleft, and they could see how this information would be helpful when encountering babies who are struggling with feeding.
This is Max, my amazing demo doll I bought from Magic Cabin Dolls. His tongue sticks out, he is intact, and anatomically correct. These sweet dolls come in different colors, genders, and are machine-washable as well.
If you have questions, or you make your own, let me know! I'd love to see what you come up with.
Almost as soon as I got the positive pregnancy test with my third baby, I started having panic attacks. I would wake up, anxious and scared, from a dead sleep. This was a surprise pregnancy that I did not plan. In my mind, the timing wasn't right.
I dealt with these panic attacks as best I could. They came in the day and in the night. When I found myself begging my husband to come home from work and help me cope, I realized I was dealing with more than just a little bit of scared feelings.
I opened up to my midwife. Being a doula and childbirth educator in the community, I felt utterly embarrassed to divulge my secret. Even though I could tell other women this was a common struggle pregnant and postpartum parents experience, I still held a deep shame that I did something wrong, that I made this happen: I felt this was my fault. Despite having a negative bias against medications used to treat emotional health issues, I must admit I was hoping my midwife would have some magic pills for me.
Instead of medication, she offered me coping strategies to move through the panic attacks. I had a ritual I was already embracing -- I would move to the recliner and begin rocking. I had a paper fan I would use to cool myself down. The TV would turn on to some benign TV show I could have to focus on, or just use as background noise. I had a blanket nearby for when I inevitably would cool down and get cold. As most of these occurred at night, I would rock and fan myself. Soon I could stop rocking and recline back into the chair, putting my feet up. Next would be the blanket, until finally sleep would come. The whole process took about an hour. My midwife offered me strategies to shorten this process, and over time, it really seemed to work.
When I say I shared with her what I was feeling, I have to say I half-shared what I was feeling. Like a half-truth, I didn't tell her the full extent of what was going on in my mind. So while my panic attacks got better, I was living with a daily truth that caused me worry without end.
I said this was a surprise pregnancy. My first two babies I planned. In my "perfect timeline of life events," I thought we would wait longer before adding a third child to our family. I spent a lot of time feeling sad about this accident. I got to the point where I was afraid to be happy, because in my mind, that was opening the door to fate -- I would be punished for my bad feelings and something would happen to my baby. I had this mental math equation in my mind always, and this is what it looked like:
I did grow happy about this new baby, and my panic attacks stopped being so present. And sure enough, as excitement and joy built up inside me, so did the knowledge that something was going to happen to my baby. My everyday reality told me, he would not be born alive. This is a hard fact to live with, and this is what I never shared with my midwife.
At every check-up, I would search my midwife's face, looking for clues she knew something was wrong. I would dwell on random words she chose, or mentally extrapolate on nil what-if's. Alone with him in my belly, I waited, knowing someday those swirling movements and gentle rumblings would stop and my reality would be borne out.
Today is November 11, 2018. Twelve years ago today I stood in my kitchen as silent tears mixed with soapy warm water, convinced sometime in the next 14 days my baby, not yet born, was going to die.
That never happened. My 12-year-old just got out of the bathtub (ordered there under threat of me scrubbing his dirty feet myself). Right now he is getting ready for bed.
Nothing happened to him in those two weeks. So what happened to me?
Cognitive distortion. There are many cognitive distortions we humans fall prey to, and the one I was living with was "emotional reasoning." Pregnancy is a time when hormones make many changes in the body, and these hormones can also make changes in the mind. In my situation, my hormones ramped up my anxiety and fear, and I interpreted these feelings as fact -- they were my truth. And I lived with them, alone, everyday for 9 months. I never told a soul what my mind was telling me.
It makes sense that hormones would influence us to prepare to be parents -- to collect together the things our babies will need, to secure a safe place to birth, and to confidently care for our little ones once they are here. Sometimes these normal feelings go into overdrive. Of course we fear something happening to our babies when they aren't near us, but needing to check on them over and over and over -- to the point that it is inturruptive to other activities -- is a normal feeling gone into overdrive. Babies come with lots of "gear," and no one wants to be caught away from home without a spare bottle or a diaper -- but choosing instead to avoid leaving the house at all, citing this as the reason why, could be a normal feeling gone into overdrive.
Cognitive distortions can come hand-in-hand with anxiety and depression. I encourage you to check out the link above for excellent information about how these look and what they do. Weekly I hear from pregnant or postpartum (which means after the baby, it's not a specific mental diagnosis) parents who are reaching out for help. Just today I had a conversation with a former doula client, friend, and new mother telling me she has finally recognized she is stuck and she cannot fix herself alone; she made an appointment to see her doctor to start the process of meeting with a therapist.
I cannot say how much strength this takes -- to reach out to someone! It can feel like the hardest thing in the world to do. As a Volunteer Support Coordinator for Postpartum Support International, I try to link families to resources. I am not a counselor or therapist, but I do have a listening ear, and I care about what families are facing. I believe PSI's mantra: "You are not alone. You are not to blame. With help, you will be well."
We hear so much about "postpartum" mood disorders, but these can actually occur during pregnancy. In fact, they do so at a higher rate. While the graphic above states 1 in 7, during pregnancy it is actually 1 in 5! Have you heard that before? I would guess sometimes mood issues in pregnancy go ignored, and then are labeled "postpartum" caused when a person shares them with their doctor or therapist after birth.
Keeping my secret was not positive in any way, shape, or form. It held me in an alternate reality where my mind was free to ignore the facts and instead, formed around emotions. Shame kept me from confiding in my very-trusted midwife. I know now she would never have wanted me to be stuck in that place alone. I know, too, she would not have blamed me in the least.
But I was afraid to tell her because then, my emotions told me she would judge me, and that judgement would last forever.
You are not alone.
You are not to blame.
With help, you will be well.
It's not easy, I know. And you can feel so much better than you feel right now.
In my experience, many pregnant people FEAR THE BIG BABY! I myself fell prey to this when pregnant with my first child. I went to an OB visit that happened to be on my due date. My doctor said to me, "Are you ready to get this over with? Because I think he's getting kind of big." In my mind, there was nothing scarier than THE BIG BABY! I didn't want THE BIG BABY! I had read in "What to Expect When You're Expecting" (or as I refer to it, "What to Expect When You're Paranoid"), that doctors don't induce unless it's medically necessary. At that time I figured if it came from my doctor's mouth, that meant it was medically necessary. And because I was afraid of THE BIG BABY, I agreed.
What can we keep in mind about THE BIG BABY?
1. Many professionals agree it is more about the position of a baby rather than the size of a baby. Babies who are face-up (posterior) can make labor longer and harder. For more about this, check out the Spinning Babies website.
2. Ultrasounds measure the length of bones, not the squish of fat. You can't tell from bone length how much your baby will weigh. There are actually different formulas for measuring and each formula produces a different estimated weight -- do you know what your doctor is using?
3. Ultrasounds have about a 15% margin of error. This could be a pound and a half either way. That pound and a half number also changes the smaller your baby is. For example, if you were told your baby would be 9 and a half pounds and your baby was 8 pounds, that's about a 16% margin or error. If you were told your baby would be 8 pounds and your baby was 6 pounds, that's a 25% margin or error.
4. The size of a baby does not tell us if the baby's lungs and other systems are mature enough to be up and running on their own. It's actually the baby who decides when to be born by releasing a hormone the placenta responds to, and then triggering labor. Read Kim James' "Close to Due Date" for the breakdown on how all of this works.
5. My experience as a doula and childbirth educator tells me most women are afraid of having THE BIG BABY! This fear is often used by professionals to get us to agree to be induced, even though this is not recommended. The American College of Obstetricians and Gynecologists states inducing for a "suspected" large baby is not evidence-based. "In cases of term patients with suspected fetal macrosomia, current evidence does not support early induction of labor. Results from recent reports indicate that induction of labor at least doubles the risk of cesarean delivery without reducing the risk of shoulder dystocia or newborn morbidity."
My first baby was induced. And he wasn't small -- he weighed 9 pounds, 8 ounces. But was he more than my body could handle? With my next baby I passed over an OB for a Certified Nurse Midwife. I remember wanting desperately to go into labor on my own, but I was also petrified of having THE BIG BABY MARK-II. In a conversation with my midwife at around 38 weeks, I said to her, "You know, if I go over my due date, I'm just going to stop eating." She looked at me wisely and replied: "His HEAD is not getting any bigger. He's just putting on fat. And fat is very squishy."
Wow. As that sank in, I had an amazing realization that more often than not, our bodies know what they're doing. My second baby kick-started an 8-hour labor at 41 weeks and 2 days. Not only did he weigh 9 pounds, 9 ounces, he came out fully face-up and with his head tilted to the side (posterior and asynclitic). Granted my doctor was right about THE BIG BABY, and then THE BIG BABY MARK II came along next. But baby three (8 pounds, 4 ounces) and baby four (8 pounds, 1 ounce) proved I could have smaller babies. Either way, there's no need to fear THE BIG BABY.
Sometimes a cesarean is necessary and a family knows this before labor begins. This gives them a chance to prepare in ways they may not have thought of during a regular labor-turned-cesarean birth.
1. Bring easy carbs to snack on -- fruit, cheese, crackers -- bring what you and your partner like to eat. Aside from the surgery aspect and the fact that you usually can't eat until you pass gas (to ensure everything is moving as it should), I suggest you just take care of yourself like you do every other day of your life -- pretend you are staying at a hotel; what would you bring food-wise to eat when you weren't able to go out? Like that 2 am snack?
2. While none of my local hospitals have mini fridges for patients and family, it is possible to bring a small ice chest for things like yogurt or drinks that you'd like to keep cool.
3. More often than not people bring too many things. Bring your own pillow, pajamas (maybe nursing night gown so no waistband to put pressure on your belly). Bring small comfort items that help you feel better -- again, things you would bring on a trip. Most hospitals provide you with a belly binder after a cesarean birth, but you should call and find out for certain. This would be a wise purchase ahead of time if you don't get one from the hospital.
4. Some families like to dress their babies in the hospital, others keep babies in the hospital shirt/diaper and just do lots of skin-to-skin...that choice is yours. Everything your baby needs during the stay will be provided. If you want your baby in special diapers, then bring those (if they are cloth, bring the necessary wet bag to store the used diapers in).
5. I suggest packing in levels -- everything you will need before your cesarean birth in one bag, everything you need for your stay in one bag, then everything you need for going home in one bag. This way you don't have to dig through the going-home outfits to find your slippers, etc.
6. They will not take your baby to give you a break, even if you request it. I had a mom who had twins and had to stay at the hospital alone as she had other children dad needed to stay with. She was exhausted and asked if a nurse would just take one baby for one hour, and the nurse said sorry, babies only leave mom if they are ill and need to be in the NICU. You can have your partner stay the night if you wish. If your partner can't stay the night, some families arrange to have a grandma stay with mom.
7. Although there are TVs in all the hospital rooms, many families do well with a tablet, phone, and/or laptop. This way you can share baby updates and pictures with family and friends, and you can watch movies or listen to music if you have a spare moment.
8. Advocate for yourself. This is a day you will never forget -- if you are receiving care that isn't up to your standards, address the situation or ask for a new caregiver. You are paying the bill and you deserve cheery, positive, helpful support, even if you choose to do things a little differently or decline traditional procedures. You can decline ANYTHING if you don't want it. Don't feel pressured, and be sure to start a conversation that is centered around shared-decision making. You are the expert of you, while your doctor is the expert regarding the medical issues. You have equal say and power in what is going on.
Women rate their birth experiences on 2 things: How in control they are, and how much support they get. This can happen in ANY kind of birth. I have seen women walk away from what looks like an amazing vaginal birth traumatized with PTSD, and I have seen women walk away from unscheduled cesarean births beaming with pride and happiness. It is mostly about how you are treated and how much say you have in how things go. Even in a cesarean birth you have options -- ask what those might be (things like listening to music during the birth, no outside conversation that doesn't relate to your baby's birth, having the drape lowered as baby is being born, etc.). Often families find they can have greater say in something because of FOMO -- the things they feel they might be missing out on during a vaginal birth. Bring these concerns up ahead of time with your provider and ask what accommodations can be made to shape this into the birth you dreamed about!
Day 11 brings us a poem from a mom of 3 who recalls her first baby's birth. She didn't want share her personal information, she simply wanted to share her poem.
Sitting still, baby kicks
Belly squeezes, baby stills
Mind races, breathing slows
The waiting time is over
The waiting time has just begun.
Ready partner, strong support
Doula helping, steady hands
Midwife present, eyes bright
The storm is calming
The storm has begun.
Eyes closed, sound within
Mother loving, triumphant face
Baby grimaces, seeking the breast
The journey is over
The journey has begun.
♥ four young boys and a boy dog (offspring)